Provider Demographics
NPI:1194317719
Name:CALVO, LEIDA J
Entity type:Individual
Prefix:
First Name:LEIDA
Middle Name:J
Last Name:CALVO
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 1:11 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-2013
Mailing Address - Country:US
Mailing Address - Phone:973-464-9679
Mailing Address - Fax:
Practice Address - Street 1:11 BERKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-2013
Practice Address - Country:US
Practice Address - Phone:973-464-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty