Provider Demographics
NPI:1518498872
Name:HOSTETTER CALLESE, OLIVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:HOSTETTER CALLESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:HOSTETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - Street 2:MEDICAL CENTER BOULEVARD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-4615
Mailing Address - Fax:336-716-6937
Practice Address - Street 1:25825 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3518
Practice Address - Country:US
Practice Address - Phone:310-325-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172062207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program