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General NPI Number Information
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NPI Number | 1083861694
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Entity Type | Organization
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Legal Business Name | BACALLAO HEALTH SERVICES CORP
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 2471 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33125-3150
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Country | US
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Telephone | 305-541-8849
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Fax | 305-541-4658
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Provider Business Mailing Address
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Address Line | 2471 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33125-3150
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Country | US
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Telephone | 305-541-8849
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Fax | 305-541-4658
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE J BACALLAO
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Credential | MD
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Telephone | 305-541-8849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME92076
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License Number State | FL
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