MEDICARE: LUDIVINA CALAZAN TACANDONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0400X	Rehabilitation Registered Nurse	445108-1	NY

General Provider Information

NPI Number	:	1114232980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUDIVINA CALAZAN TACANDONG

Provider Business Mailing Address
First Line	:	86 TOUISSANT AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710-5425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 HOLLAND AVENUE
Second Line	:
City	:	BRONX
State	:	NEW YORK
Zip	:	10467
Country	:	UM
Telephone Number	:	718-655-8916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	08/17/2010

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