Provider Demographics
NPI:1457775850
Name:COLARUSSO, CALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:COLARUSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1020 PROSPECT ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0068
Mailing Address - Country:US
Mailing Address - Phone:858-454-2473
Mailing Address - Fax:858-454-4192
Practice Address - Street 1:1020 PROSPECT ST
Practice Address - Street 2:SUITE 415
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0068
Practice Address - Country:US
Practice Address - Phone:858-454-2473
Practice Address - Fax:858-454-4192
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC288452084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry