MEDICARE: CALLA SLIM SPA

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	132700000X	Dietary Manager

General Provider Information

NPI Number	:	1962662445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALLA SLIM SPA

Provider Business Mailing Address
First Line	:	444 W NEW ENGLAND AVE
Second Line	:	SUITE 121
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4224
Country	:	US
Telephone Number	:	407-644-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 W NEW ENGLAND AVE
Second Line	:	SUITE 121
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4224
Country	:	US
Telephone Number	:	407-644-7546
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	SUZANNE GIL
Credential	:	MD
Telephone Number	:	407-644-7546

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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