Provider Demographics
NPI:1740244664
Name:CALIVOSO, ANGELO MEDINA (MSO)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:MEDINA
Last Name:CALIVOSO
Suffix:
Gender:M
Credentials:MSO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:36283 VERAMONTE AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6505
Mailing Address - Country:US
Mailing Address - Phone:619-578-4009
Mailing Address - Fax:
Practice Address - Street 1:NORFOLK NAVAL BASE - CSU EAST
Practice Address - Street 2:581 A ST BLDG SP-312 ROOM 115
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511
Practice Address - Country:US
Practice Address - Phone:757-443-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians