MR. TRACY SCOTT MACCALLUM (NPI# 1780709899) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1780709899 |
Entity Type | Individual |
Full Name | MR. TRACY SCOTT MACCALLUM |
Credential | LMT |
Practice Address |
6926 Brockton Ave #8 Riverside CA 92506-3804 |
Mailing Address |
813 Navajo Dr Riverside CA 92507-6048 |
Practice Telephone | 9513475179 |
Practice Fax Number | 9517799541 |
Mailing Telephone | 9513475179 |
Mailing Fax Number | 9517799541 |
Enumeration Date | 2007-03-20 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
X | 174400000X | Specialist | MT007176 | TX | Other Service Providers |
X | 174400000X | Specialist | 1462 | NM | Other Service Providers |
Street Address |
6926 BROCKTON AVE #8 |
City | RIVERSIDE |
State | CA |
Zip Code | 92506-3804 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386611242 | Herman A Carstens | Obstetrics & Gynecology | 6926 Brockton Ave, Suite 7, Riverside, CA 92506-3804 | 2006-02-28 |
1730723677 | Kathryn Rachel Porter | Pediatrics | 6926 Brockton Ave, Riverside, CA 92506-3800 | 2019-11-04 |
1780076034 | Negeen Zareh, D.m.d., Inc., A Professional Corporation | Dentist | 6926 Brockton Ave, Suite 3, Riverside, CA 92506-3800 | 2015-02-24 |
1184028557 | Herman A Carstens Md Clinic of Obstetrics and Gynecology P C | Obstetrics & Gynecology | 6926 Brockton Ave, Suite 7, Riverside, CA 92506-3800 | 2014-10-14 |
1831510353 | Lauren Seastrom Hunt | Nurse Practitioner | 6926 Brockton Ave, Suite 6, Riverside, CA 92506-3804 | 2013-12-31 |
1841534302 | Hubert C. Watkins, M.d., Inc. | Clinic/Center | 6926 Brockton Ave, Suite 10, Riverside, CA 92506-3800 | 2012-11-21 |
1457544983 | Susan Katali Wagner | Respiratory Therapist, Certified | 6926 Brockton Ave, Ste 9, Riverside, CA 92506-3800 | 2007-08-17 |
1346431145 | Edilberto Lumelay Agas Jr. | Pediatrics | 6926 Brockton Ave, Suite 6, Riverside, CA 92506-3800 | 2007-08-06 |
1811103823 | Naresh Kumar Sharma | Orthopaedic Surgery | 6926 Brockton Ave, Suite 11, Riverside, CA 92506 | 2007-05-15 |
1750419438 | Mission Pediatrics, Inc. | Pediatrics | 6926 Brockton Ave, Ste 6, Riverside, CA 92506-3804 | 2007-03-02 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902405715 | Riverside Primary Care Clinic, Joanna Ayala Md | Clinic/Center | 3978 Merrill Ave, Riverside, CA 92506 | 2020-10-22 |
1336747005 | Beatriz Arredondo | Behavioral Analyst | 6117 Brockton Avenue Ste. 202, Riverside, CA 92506 | 2020-10-14 |
1740756782 | Priscilla Marie Rodriguez | Social Worker | 3742 Tibbets St Suite 201, Riverside, CA 92506 | 2018-10-17 |
1922593946 | Prevail Health Solutions, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 7450 Chateau Ridge Ln, Riverside, CA 92506 | 2018-06-22 |
1831691880 | Mckinley Children's Center | Community/Behavioral Health | 6700 Indiana Avenue, Suite 280, Riverside, CA 92506 | 2018-03-06 |
1720590946 | Leticia Dilworth | Behavioral Analyst | 3610 Central Ave Ste 46, Riverside, CA 92506 | 2017-10-27 |
1548771736 | Usa Biosciences LLC | Clinical Medical Laboratory | 5750 Division St Ste 109, Riverside, CA 92506 | 2017-10-16 |
1922542273 | Yazmar Sevilla-perez | Physical Therapist | 6852 Brockton Ave., Suite 212, Riverside, CA 92506 | 2016-12-06 |
1821547605 | Pathway To Healing, Marriage and Family Therapy, Inc. | Marriage & Family Therapist | 5790 Magnolia Ave., Ste 202, Rm F, Riverside, CA 92506 | 2016-09-22 |
1952857542 | Kramer and Nguyen Dental Corporation | Dentist | 3602 Riverside Plaza Dr, Ste 101, Riverside, CA 92506 | 2016-09-01 |
Find all providers in zip 92506 |
Taxonomy Code | 174400000X |
Grouping | Other Service Providers |
Classification | Specialist |
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
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1699383661 | Transgender Health and Wellness Center | Specialist | 6700 Indiana Ave Ste 252, Riverside, CA 92506-4264 | 2020-07-16 |
1295350668 | Bette Graff | Specialist | 4148 10th St, Riverside, CA 92501-3110 | 2020-06-11 |
1295275808 | Eastern Comprehensive Medical Services | Specialist | 106 Sheephill Rd, Riverside, CT 06878-1120 | 2017-03-01 |
1245778331 | Lynn Nevatt | Specialist | 3833 Jurupa Ave, Riverside, CA 92506-2221 | 2017-02-08 |
1093264145 | Nephrology Associates Medical Group, Inc. | Specialist | 3660 Park Sierra Dr Ste 203, Riverside, CA 92505-3071 | 2016-09-30 |
1639625247 | Dana Keim | Specialist | 6864 Indiana Ave Ste 104a, Riverside, CA 92506 | 2016-09-01 |
1720401615 | Matthew Martinez | Specialist | 8205 Coleman St, Riverside, CA 92504-3107 | 2014-01-28 |
1649512575 | Michael C Luciano | Specialist | 3120 Chicago Ave, Suite #170, Riverside, CA 92507-3490 | 2013-03-18 |
1508110461 | Luis Angel Calvillo Jr. | Specialist | 246 Plews Ct, Riverside, CA 92507-1100 | 2012-10-30 |
1639474513 | Jeanne Dunkel | Specialist | 3529 Hoover St, Riverside, CA 92504-3907 | 2011-01-24 |
Find all providers in RIVERSIDE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.