Provider Demographics
NPI:1366717431
Name:ESTELITA B. CALICA, M.D., APC.
Entity type:Organization
Organization Name:ESTELITA B. CALICA, M.D., APC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-546-1515
Mailing Address - Street 1:1505 WILSON TER STE 230
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4074
Mailing Address - Country:US
Mailing Address - Phone:818-546-1515
Mailing Address - Fax:
Practice Address - Street 1:1505 WILSON TER STE 230
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4074
Practice Address - Country:US
Practice Address - Phone:818-546-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC411892084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37548Medicare UPIN
CAC41189Medicare PIN