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Individual

BREIDI A. CALLOWAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1441 EASTLAKE AVE, NOR 8302E, LOS ANGELES, CA 90089-0112
(323) 865-3105
(323) 865-0061
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-5100

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
18343
CA
261QX0200X
Oncology Clinic/Center
18343
CA
363L00000X
Nurse Practitioner
Primary
18343
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1902846306
GROUP NPI
CA
01
GR0100430
GROUP MEDICAL
CA
01
W18762
GROUP MEDICARE
CA
Enumeration date
12/23/2010
Last updated
04/03/2012
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