Provider Demographics
NPI:1275932394
Name:MCCALL, SEAMUS
Entity Type:Individual
Prefix:
First Name:SEAMUS
Middle Name:
Last Name:MCCALL
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 1:5607 MOUNT MURPHY ROAD
Mailing Address - Street 2:
Mailing Address - City:GARDEN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95633
Mailing Address - Country:US
Mailing Address - Phone:530-333-9460
Mailing Address - Fax:530-333-1019
Practice Address - Street 1:5607 MOUNT MURPHY ROAD
Practice Address - Street 2:
Practice Address - City:GARDEN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95633
Practice Address - Country:US
Practice Address - Phone:530-333-9460
Practice Address - Fax:530-333-1019
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI3001213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI3001213OtherCADCA