Provider Demographics
NPI:1114738705
Name:CALLE, MAGALI GEOCONDA
Entity type:Individual
Prefix:
First Name:MAGALI
Middle Name:GEOCONDA
Last Name:CALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 AARONS WAY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-2596
Mailing Address - Country:US
Mailing Address - Phone:508-760-2054
Mailing Address - Fax:508-760-1218
Practice Address - Street 1:21 AARONS WAY UNIT 2
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-2596
Practice Address - Country:US
Practice Address - Phone:508-760-2054
Practice Address - Fax:508-760-1218
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2024088145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily