Provider Demographics
NPI:1578156253
Name:CALDERIN, LISAMARY
Entity Type:Individual
Prefix:
First Name:LISAMARY
Middle Name:
Last Name:CALDERIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 SW 136TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2346
Mailing Address - Country:US
Mailing Address - Phone:786-282-2068
Mailing Address - Fax:
Practice Address - Street 1:6725 SW 136TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2346
Practice Address - Country:US
Practice Address - Phone:786-282-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIN-436-44-467374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC436-520-96-595-0OtherID LICENSE