Healthcare Provider Details

I. General information

NPI: 1003172610
Provider Name (Legal Business Name): IVONNE CALCEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 PURITAN RD
ORLANDO FL
32807-8411
US

IV. Provider business mailing address

7501 PURITAN RD
ORLANDO FL
32807-8411
US

V. Phone/Fax

Practice location:
  • Phone: 407-591-2694
  • Fax: 407-830-0220
Mailing address:
  • Phone: 407-591-2694
  • Fax: 407-830-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: