Healthcare Provider Details

I. General information

NPI: 1982750675
Provider Name (Legal Business Name): MARIA O CALEJO ITDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 12 AVE UNIVERSITY OF MIAMI - EARLY STEPS PROGRAM
MIAMI FL
33136
US

IV. Provider business mailing address

1601 NW 12 AVE UNIVERSITY OF MIAMI - EARLY STEPS PROGRAM
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6660
  • Fax: 305-243-3501
Mailing address:
  • Phone: 305-243-6660
  • Fax: 305-243-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number103TE1000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: