Provider Demographics
NPI:1053188045
Name:WORRELL, CALVIN JAMES (PA)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:JAMES
Last Name:WORRELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 N MELPOMENE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9768
Mailing Address - Country:US
Mailing Address - Phone:928-856-1862
Mailing Address - Fax:
Practice Address - Street 1:2842 N MELPOMENE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9768
Practice Address - Country:US
Practice Address - Phone:928-856-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program