Provider Demographics
NPI:1124876776
Name:CALLON, LUCIENE TEIXEIRA
Entity type:Individual
Prefix:
First Name:LUCIENE
Middle Name:TEIXEIRA
Last Name:CALLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 MARTIN ST # 1
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4045
Mailing Address - Country:US
Mailing Address - Phone:360-788-4228
Mailing Address - Fax:360-778-1423
Practice Address - Street 1:288 MARTIN ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4045
Practice Address - Country:US
Practice Address - Phone:360-788-4228
Practice Address - Fax:360-788-1423
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program