Provider Demographics
NPI:1760587992
Name:THOMAS A. O'CALLAGHAN
Entity Type:Organization
Organization Name:THOMAS A. O'CALLAGHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'CALLAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-794-9039
Mailing Address - Street 1:1741 STRATFORD CIR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4229
Mailing Address - Country:US
Mailing Address - Phone:909-794-9039
Mailing Address - Fax:909-794-9286
Practice Address - Street 1:4646 BROCKTON AVE
Practice Address - Street 2:SUITE 301-1A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0102
Practice Address - Country:US
Practice Address - Phone:951-784-2866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42550146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty