Healthcare Provider Details

I. General information

NPI: 1972131241
Provider Name (Legal Business Name): GUIANELLA ESTHER CALA BALMASEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 10/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 SW 42ND AVE
CORAL GABLES FL
33134-1962
US

IV. Provider business mailing address

8912 W FLAGLER ST APT 216
MIAMI FL
33174-3943
US

V. Phone/Fax

Practice location:
  • Phone: 305-701-1932
  • Fax:
Mailing address:
  • Phone: 786-606-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27363
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: