Healthcare Provider Details

I. General information

NPI: 1083076657
Provider Name (Legal Business Name): SEBASTIAN GABRIEL DE LA CALLE AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 04/21/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL USAG-HUMPHREYS, BLDG # 3030, UNIT 15245
APO AP
96271-5245
US

IV. Provider business mailing address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL USAG-HUMPHREYS, BLDG # 3030, UNIT 15245
APO AP
96271-5245
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-2836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: