Healthcare Provider Details

I. General information

NPI: 1790353258
Provider Name (Legal Business Name): ROSANGELA TIZA CALDERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 NW 7TH ST
MIAMI FL
33125-3569
US

IV. Provider business mailing address

18761 SW 291ST TER
HOMESTEAD FL
33030-3014
US

V. Phone/Fax

Practice location:
  • Phone: 786-542-5188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: