Individual
MR. ANGELO MEDINA CALIVOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSO
Contact information
Practice address
NORFOLK NAVAL BASE - CSU EAST, 581 A ST BLDG SP-312 ROOM 115, NORFOLK, VA 23511
(757) 443-5760
Mailing address
36283 VERAMONTE AVE, MURRIETA, CA 92562-6505
(619) 578-4009
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
04/17/2006
Last updated
01/22/2019
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