Provider Demographics
NPI:1003117425
Name:CALICCHIO, KRISTINA WYNN (DVM)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:WYNN
Last Name:CALICCHIO
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6394 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4952
Mailing Address - Country:US
Mailing Address - Phone:305-666-4142
Mailing Address - Fax:305-661-2434
Practice Address - Street 1:6394 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4952
Practice Address - Country:US
Practice Address - Phone:305-666-4142
Practice Address - Fax:305-661-2434
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM11042174M00000X
CA15228174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian