Provider Demographics
NPI:1407457948
Name:CALZADILLAS, GISELA OLIVIA (SLP)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:OLIVIA
Last Name:CALZADILLAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13711 VAN NUYS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3638
Mailing Address - Country:US
Mailing Address - Phone:818-206-8217
Mailing Address - Fax:
Practice Address - Street 1:13711 VAN NUYS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3638
Practice Address - Country:US
Practice Address - Phone:818-206-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist