Provider Demographics
NPI:1770859118
Name:CLARICE CAMPOSANO CALOPIZ, MD, INC
Entity Type:Organization
Organization Name:CLARICE CAMPOSANO CALOPIZ, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:CAMPOSANO
Authorized Official - Last Name:CALOPIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-867-7136
Mailing Address - Street 1:3875 CARTER DR
Mailing Address - Street 2:NO. 205
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3886
Mailing Address - Country:US
Mailing Address - Phone:650-867-7136
Mailing Address - Fax:
Practice Address - Street 1:1213 EATON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5233
Practice Address - Country:US
Practice Address - Phone:650-593-7861
Practice Address - Fax:650-593-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI43152Medicare UPIN