Provider Demographics
NPI:1306192992
Name:MCCALLIAN, RANDAL J
Entity Type:Individual
Prefix:MS
First Name:RANDAL
Middle Name:J
Last Name:MCCALLIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 BERNARD CIR
Mailing Address - Street 2:#203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4726
Mailing Address - Country:US
Mailing Address - Phone:720-933-4005
Mailing Address - Fax:
Practice Address - Street 1:5156 BERNARD CIR
Practice Address - Street 2:#203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-4726
Practice Address - Country:US
Practice Address - Phone:720-933-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
#9053374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula