Healthcare Provider Details

I. General information

NPI: 1285787374
Provider Name (Legal Business Name): JUAN E CALERO L.S.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN E CALERO L.S.A

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/15/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SARNO RD SUITE 15
MELBOURNE FL
32935-4938
US

IV. Provider business mailing address

3100 W END AVE SUITE 800
NASHVILLE TN
37203-1320
US

V. Phone/Fax

Practice location:
  • Phone: 800-348-4565
  • Fax: 888-468-6511
Mailing address:
  • Phone: 615-345-5400
  • Fax: 888-468-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00881
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number03-144
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: