Provider Demographics
NPI:1407908908
Name:NILZA KALLOS, M.D., P.A.
Entity Type:Organization
Organization Name:NILZA KALLOS, M.D., P.A.
Other - Org Name:BREAST HEALTH CENTER AND DIAGNOSTIC ULTRASOUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NILZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-665-2223
Mailing Address - Street 1:7000 S.W. 62 AVE.
Mailing Address - Street 2:PENTHOUSE A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4721
Mailing Address - Country:US
Mailing Address - Phone:305-665-2223
Mailing Address - Fax:
Practice Address - Street 1:7000 S.W. 62 AVE.
Practice Address - Street 2:PENTHOUSE A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4721
Practice Address - Country:US
Practice Address - Phone:305-665-2223
Practice Address - Fax:305-663-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77357Medicare ID - Type Unspecified