MEDICARE: MR. ERIC PELEGRIN CALAFORRA LMHC, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9515994	FL
2	101YM0800X	Mental Health Counselor	MH16622	FL

General Provider Information

NPI Number	:	1851996722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC PELEGRIN CALAFORRA LMHC, RN

Provider Business Mailing Address
First Line	:	1021 W 59TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2307
Country	:	US
Telephone Number	:	786-488-3235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 W 59TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2307
Country	:	US
Telephone Number	:	786-488-3235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/04/2020

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