Healthcare Provider Details

I. General information

NPI: 1962662445
Provider Name (Legal Business Name): CALLA SLIM SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W NEW ENGLAND AVE SUITE 121
WINTER PARK FL
32789-4224
US

IV. Provider business mailing address

444 W NEW ENGLAND AVE SUITE 121
WINTER PARK FL
32789-4224
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-7546
  • Fax:
Mailing address:
  • Phone: 407-644-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE GIL
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 407-644-7546