Provider Demographics
NPI:1467345215
Name:SURCA-CALVO, KAYSE JULISSA
Entity type:Individual
Prefix:
First Name:KAYSE
Middle Name:JULISSA
Last Name:SURCA-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:973-851-0095
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:973-851-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty