Healthcare Provider Details

I. General information

NPI: 1407908908
Provider Name (Legal Business Name): NILZA KALLOS, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 S.W. 62 AVE. PENTHOUSE A
MIAMI FL
33143-4721
US

IV. Provider business mailing address

7000 S.W. 62 AVE. PENTHOUSE A
MIAMI FL
33143-4721
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-2223
  • Fax: 305-663-6783
Mailing address:
  • Phone: 305-665-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NILZA KALLOS
Title or Position: OWNER
Credential: M.D.
Phone: 305-665-2223