Provider Demographics
NPI:1952868218
Name:CAL SPORT PHYSICAL MEDICINE INC
Entity Type:Organization
Organization Name:CAL SPORT PHYSICAL MEDICINE INC
Other - Org Name:CAL SPORT PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-682-6140
Mailing Address - Street 1:157 S SIERRA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-4049
Mailing Address - Country:US
Mailing Address - Phone:209-322-2636
Mailing Address - Fax:
Practice Address - Street 1:157 S SIERRA AVE STE B
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-4049
Practice Address - Country:US
Practice Address - Phone:209-322-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty