Provider Demographics
NPI:1912351511
Name:CALLOWAY, DAVID RAY
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RAY
Last Name:CALLOWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CITY PKWY W FL 4
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2941
Mailing Address - Country:US
Mailing Address - Phone:714-834-2951
Mailing Address - Fax:714-834-8235
Practice Address - Street 1:500 CITY PKWY W FL 4
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2941
Practice Address - Country:US
Practice Address - Phone:714-834-2951
Practice Address - Fax:714-834-8235
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health