Provider Demographics
NPI:1871518977
Name:CALLISTER, CYRIL BRUCE (PA-C)
Entity type:Individual
Prefix:
First Name:CYRIL
Middle Name:BRUCE
Last Name:CALLISTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3424
Mailing Address - Country:US
Mailing Address - Phone:510-204-8290
Mailing Address - Fax:510-273-8977
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-204-8290
Practice Address - Fax:510-273-8977
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20991363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS49539Medicare UPIN
UT005505407Medicare ID - Type Unspecified