Provider Demographics
NPI:1396188421
Name:MCCALLISTER, CRUZ GLORIA
Entity Type:Individual
Prefix:
First Name:CRUZ
Middle Name:GLORIA
Last Name:MCCALLISTER
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 1:128 SUNSHINE CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4724
Mailing Address - Country:US
Mailing Address - Phone:707-778-2223
Mailing Address - Fax:
Practice Address - Street 1:128 SUNSHINE CT
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4724
Practice Address - Country:US
Practice Address - Phone:707-778-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker