Healthcare Provider Details

I. General information

NPI: 1780726851
Provider Name (Legal Business Name): MANUEL E. CALZADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#31 RD,13.4 KM BARRIO PENA POBRE
NAGUABO PR
00718
US

IV. Provider business mailing address

PO BOX 7768
CAGUAS PR
00726-7768
US

V. Phone/Fax

Practice location:
  • Phone: 787-874-2912
  • Fax: 787-874-1324
Mailing address:
  • Phone: 787-874-2912
  • Fax: 787-874-1324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10746
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: