Healthcare Provider Details

I. General information

NPI: 1114738705
Provider Name (Legal Business Name): MAGALI GEOCONDA CALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 AARONS WAY UNIT 2
WEST YARMOUTH MA
02673-2596
US

IV. Provider business mailing address

21 AARONS WAY UNIT 2
WEST YARMOUTH MA
02673-2596
US

V. Phone/Fax

Practice location:
  • Phone: 508-760-2054
  • Fax: 508-760-1218
Mailing address:
  • Phone: 508-760-2054
  • Fax: 508-760-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024088145
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: