Provider Demographics
NPI:1235003930
Name:KALLAY, TAVAI
Entity type:Individual
Prefix:MRS
First Name:TAVAI
Middle Name:
Last Name:KALLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 TOWER DR STE 10
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4270
Mailing Address - Country:US
Mailing Address - Phone:432-331-2780
Mailing Address - Fax:432-203-9764
Practice Address - Street 1:808 TOWER DR STE 10
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4270
Practice Address - Country:US
Practice Address - Phone:432-331-2780
Practice Address - Fax:432-203-9764
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other