Provider Demographics
NPI:1659608875
Name:CALIXTO-PEREZ, NICOLE (MS CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:CALIXTO-PEREZ
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CALIXTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CFY-SLP
Mailing Address - Street 1:10300 SW 72ND ST STE 280
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3032
Mailing Address - Country:US
Mailing Address - Phone:305-598-5589
Mailing Address - Fax:305-598-5477
Practice Address - Street 1:10300 SW 72ND ST STE 280
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3032
Practice Address - Country:US
Practice Address - Phone:305-598-5589
Practice Address - Fax:305-598-5477
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 5658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist