Provider Demographics
NPI:1265550677
Name:CALUYA, MARISSA TAGABAN (MD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:TAGABAN
Last Name:CALUYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N PEPPER AVE
Mailing Address - Street 2:PEDIATRICS ADMINISTRATION
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1819
Mailing Address - Country:US
Mailing Address - Phone:855-422-8029
Mailing Address - Fax:909-580-1438
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:PEDIATRICS ADMINISTRATION
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1819
Practice Address - Country:US
Practice Address - Phone:855-422-8029
Practice Address - Fax:909-580-1438
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics