Healthcare Provider Details

I. General information

NPI: 1457788796
Provider Name (Legal Business Name): DR. WILMAN BLADIMIR OLMEDO CALDERON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 GUION PL
NEW ROCHELLE NY
10801-5502
US

IV. Provider business mailing address

50 GUION PL APARTMENT 6F
NEW ROCHELLE NY
10801-5512
US

V. Phone/Fax

Practice location:
  • Phone: 914-632-5000
  • Fax:
Mailing address:
  • Phone: 818-534-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number61119
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: