Provider Demographics
NPI:1619154333
Name:CALZADILLA, CARISSA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:LYNN
Last Name:CALZADILLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 DUCK SLOUGH BLVD.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-375-7578
Mailing Address - Fax:
Practice Address - Street 1:2154 DUCK SLOUGH BLVD.
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-375-7578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49971174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist