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General NPI Number Information
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NPI Number | 1609602895
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Entity Type | Individual
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Provider Name | LUIZA LABORNE SOUSA PINTO KALIL MD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 2 CHURCH ST S, #401
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City | NEW HAVEN
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State | CT
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Zip | 06519
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Country | US
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Telephone | 203-785-3482
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Fax |
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Provider Business Mailing Address
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Address Line | 2 CHURCH ST S STE 401
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City | NEW HAVEN
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State | CT
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Zip | 06519-1717
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Country | US
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Telephone | 475-450-4445
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 1.077164
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License Number State | CT
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