Provider Demographics
NPI:1528007887
Name:CALZADA, PABLO JOSE (DO)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:JOSE
Last Name:CALZADA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-6896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256735100Medicaid
H02782Medicare UPIN
FL256735100Medicaid