MEDICARE: GILDA MARIA DE LA CALLE MD PA

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	208D00000X	General Practice Physician	ME90679	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386743896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILDA MARIA DE LA CALLE MD PA

Provider Business Mailing Address
First Line	:	1435 W 49TH PL STE 400B
Second Line	:	SUITE 400B
City	:	HIALEAH
State	:	FL
Zip	:	33012-3107
Country	:	US
Telephone Number	:	305-823-5730
Fax Number	:	305-823-5732

Provider Business Practice Location Address
First Line	:	1790 W 49TH ST
Second Line	:	SUITE 303
City	:	HIALEAH
State	:	FL
Zip	:	33012-2992
Country	:	US
Telephone Number	:	305-823-5730
Fax Number	:	305-823-5732

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GILDA MARIA DE LA CALLE
Credential	:	MD
Telephone Number	:	305-823-5730

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/21/2010

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