Provider Demographics
NPI:1386743896
Name:GILDA MARIA DE LA CALLE MD PA
Entity type:Organization
Organization Name:GILDA MARIA DE LA CALLE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DE LA CALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-823-5730
Mailing Address - Street 1:1435 W 49TH PL STE 400B
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3107
Mailing Address - Country:US
Mailing Address - Phone:305-823-5730
Mailing Address - Fax:305-823-5732
Practice Address - Street 1:1790 W 49TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2992
Practice Address - Country:US
Practice Address - Phone:305-823-5730
Practice Address - Fax:305-823-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90679208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270053100Medicaid
FL270053100Medicaid