Provider Demographics
NPI:1225301013
Name:CALZADA PRIMARY CARE, PA
Entity Type:Organization
Organization Name:CALZADA PRIMARY CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALZADA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-987-4900
Mailing Address - Street 1:2261 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3623
Mailing Address - Country:US
Mailing Address - Phone:954-987-4900
Mailing Address - Fax:954-987-4922
Practice Address - Street 1:2261 N UNIVERSITY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3623
Practice Address - Country:US
Practice Address - Phone:954-987-4900
Practice Address - Fax:954-987-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256735100Medicaid
FLH02782Medicare UPIN
FL256735100Medicaid