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General NPI Number Information
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NPI Number | 1407453277
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Entity Type | Individual
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Provider Name | MS. PRINCESS LAQA CALLAHAN
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Gender | Female
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 2620 NW 19TH ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33311-3324
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Country | US
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Telephone | 786-659-2598
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Fax |
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Provider Business Mailing Address
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Address Line | 609 SW 75TH AVE
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-1346
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Country | US
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Telephone | 786-955-4239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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