Provider Demographics
NPI:1720395080
Name:CALIVA, LIEZEL (HIS)
Entity Type:Individual
Prefix:MS
First Name:LIEZEL
Middle Name:
Last Name:CALIVA
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4054
Mailing Address - Country:US
Mailing Address - Phone:408-540-5400
Mailing Address - Fax:408-540-5419
Practice Address - Street 1:3071 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4054
Practice Address - Country:US
Practice Address - Phone:408-540-5400
Practice Address - Fax:408-540-5419
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7617237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist