Provider Demographics
NPI:1588265607
Name:CALZADA, MARIA GUADALUPE
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:CALZADA
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 1:442 STEELE CT
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4038
Mailing Address - Country:US
Mailing Address - Phone:224-237-7561
Mailing Address - Fax:
Practice Address - Street 1:1500 S DOUGLAS RD STE 230
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4108
Practice Address - Country:US
Practice Address - Phone:844-854-1116
Practice Address - Fax:305-846-9711
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
ILRBT-20-141824106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician