Basic Information
Provider Information
NPI: 1588265607
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALZADA
FirstName: MARIA
MiddleName: GUADALUPE
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 442 STEELE CT
Address2:  
City: WAUKEGAN
State: IL
PostalCode: 600854038
CountryCode: US
TelephoneNumber: 2242377561
FaxNumber:  
Practice Location
Address1: 1500 S DOUGLAS RD STE 230
Address2:  
City: CORAL GABLES
State: FL
PostalCode: 331344108
CountryCode: US
TelephoneNumber: 8448541116
FaxNumber: 3058469711
Other Information
ProviderEnumerationDate: 11/04/2020
LastUpdateDate: 10/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  N    
106S00000XRBT-20-141824ILY    

No ID Information.


Home