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General NPI Number Information
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NPI Number | 1679538664
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Entity Type | Organization
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Legal Business Name | SANTA ROSA DE LIMA MEDICAL PA
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 11/27/2008
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Provider Practice Location Address
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Address Line | 1055 SAXON BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8468
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Country | US
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Telephone | 407-268-5415
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Fax |
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Provider Business Mailing Address
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Address Line | 4916 SAN MARINO CIR C/O S. CALDERON, MD
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City | LAKE MARY
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State | FL
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Zip | 32746-2608
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Country | US
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Telephone | 407-268-5415
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANTIAGO W. CALDERON
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Credential | M.D.
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Telephone | 407-268-5415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME70874
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License Number State | FL
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