Provider Demographics
NPI:1912154865
Name:CALDERON AMEZQUITA, YEMAL (MD)
Entity type:Individual
Prefix:
First Name:YEMAL
Middle Name:
Last Name:CALDERON AMEZQUITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YEMAL
Other - Middle Name:
Other - Last Name:CALDERON AMEZQUITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3061 SW 192ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5826
Mailing Address - Country:US
Mailing Address - Phone:787-347-1735
Mailing Address - Fax:
Practice Address - Street 1:2001 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1801
Practice Address - Country:US
Practice Address - Phone:305-823-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111019207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1912154865Medicaid