Provider Demographics
NPI:1568280121
Name:SPELLMAN, CALVIN
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:SPELLMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 BEACON BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3467
Mailing Address - Country:US
Mailing Address - Phone:916-462-3100
Mailing Address - Fax:
Practice Address - Street 1:3050 BEACON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3467
Practice Address - Country:US
Practice Address - Phone:916-462-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker