Provider Demographics
NPI:1720467855
Name:SPIVEY, CALVIN (HHP)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 CALGARY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2509
Mailing Address - Country:US
Mailing Address - Phone:619-719-1644
Mailing Address - Fax:
Practice Address - Street 1:2180 GARNET AVE
Practice Address - Street 2:SUITE 3L
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3610
Practice Address - Country:US
Practice Address - Phone:619-719-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58460225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist