Provider Demographics
NPI:1780787606
Name:CALICA, DAVID RICHARD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:CALICA
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 1:3 BLANCHARD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3455
Mailing Address - Country:US
Mailing Address - Phone:949-856-1835
Mailing Address - Fax:
Practice Address - Street 1:16200 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3714
Practice Address - Country:US
Practice Address - Phone:949-753-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58818207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G588180Medicaid
CA00G588180Medicaid