Provider Demographics
NPI:1447328356
Name:MCCALL, REDGIE ARLAN JR (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:REDGIE
Middle Name:ARLAN
Last Name:MCCALL
Suffix:JR
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:454 W NORTHRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2037
Mailing Address - Country:US
Mailing Address - Phone:909-395-5509
Mailing Address - Fax:
Practice Address - Street 1:390 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE # 1000
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4475
Practice Address - Country:US
Practice Address - Phone:310-640-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17428363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical