Healthcare Provider Details

I. General information

NPI: 1174622682
Provider Name (Legal Business Name): GILDA M DE LA CALLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10775 SW 56TH ST
MIAMI FL
33165-7043
US

IV. Provider business mailing address

10775 SW 56TH ST
MIAMI FL
33165-7043
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-4219
  • Fax: 786-360-4217
Mailing address:
  • Phone: 786-360-4219
  • Fax: 786-360-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME90679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: