Healthcare Provider Details

I. General information

NPI: 1346003118
Provider Name (Legal Business Name): CALIDA TAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-2558
US

IV. Provider business mailing address

5915 S RAINBOW BLVD STE 100
LAS VEGAS NV
89118-2558
US

V. Phone/Fax

Practice location:
  • Phone: 702-666-8808
  • Fax: 702-362-9954
Mailing address:
  • Phone: 702-666-8808
  • Fax: 702-362-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: