Provider Demographics
NPI:1346821006
Name:CALAUSTRO, LEO
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:CALAUSTRO
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 1:8290 CRYSTAL WALK CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8081
Mailing Address - Country:US
Mailing Address - Phone:916-662-6034
Mailing Address - Fax:
Practice Address - Street 1:8290 CRYSTAL WALK CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8081
Practice Address - Country:US
Practice Address - Phone:916-662-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1103980156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist