Provider Demographics
NPI:1083907422
Name:FALLGATTER, WILLIAM CALVIN
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CALVIN
Last Name:FALLGATTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 JASON ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2813
Mailing Address - Country:US
Mailing Address - Phone:661-588-9091
Mailing Address - Fax:661-588-9091
Practice Address - Street 1:2001 JASON ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2813
Practice Address - Country:US
Practice Address - Phone:661-588-9091
Practice Address - Fax:661-588-9091
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384071171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications