Provider Demographics
NPI:1215151675
Name:CALLENDER, JAY H (LAC)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:CALLENDER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5157
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-5157
Mailing Address - Country:US
Mailing Address - Phone:707-328-2087
Mailing Address - Fax:
Practice Address - Street 1:2448 GUERNEVILLE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-4175
Practice Address - Country:US
Practice Address - Phone:707-542-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist