Provider Demographics
NPI:1336373901
Name:CALAYAG, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:CALAYAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3217
Mailing Address - Country:US
Mailing Address - Phone:714-456-6966
Mailing Address - Fax:
Practice Address - Street 1:200 S MANCHESTER AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3217
Practice Address - Country:US
Practice Address - Phone:714-456-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137268207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery