Provider Demographics
NPI:1538805445
Name:ALCALA, ANTHONY LEE (BSN)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEE
Last Name:ALCALA
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10754 SAND CASTLE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4272
Mailing Address - Country:US
Mailing Address - Phone:209-298-5549
Mailing Address - Fax:
Practice Address - Street 1:10754 SAND CASTLE WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4272
Practice Address - Country:US
Practice Address - Phone:209-298-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA845846163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health