Provider Demographics
NPI:1164771358
Name:CALVERT, DAN L
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:L
Last Name:CALVERT
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 1:3909 MONROE AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4666
Mailing Address - Country:US
Mailing Address - Phone:619-920-4244
Mailing Address - Fax:
Practice Address - Street 1:3909 MONROE AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4666
Practice Address - Country:US
Practice Address - Phone:619-920-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst