Provider Demographics
NPI:1306866900
Name:CALMAC, ROXANA E (MD)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:E
Last Name:CALMAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:11815 EDUCATION STREET
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602
Practice Address - Country:US
Practice Address - Phone:530-886-6558
Practice Address - Fax:530-889-6035
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA94362207R00000X
SD5892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5892OtherLICENSE
SD5892OtherLICENSE
SDP00391243Medicare PIN
CAES275ZMedicare PIN