Individual
DR. NIV E DECALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
225 N JACKSON AVE, SAN JOSE, CA 95116
(408) 259-5000
Mailing address
250 CHERRY LN STE 116, MANTECA, CA 95337-4398
(209) 647-2184
(209) 647-4684
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A120987
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053511667
—
CT
Enumeration date
07/21/2007
Last updated
03/29/2019
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