Provider Demographics
NPI:1659783629
Name:CALCANO VILLEGAS, DANNIELLA
Entity Type:Individual
Prefix:
First Name:DANNIELLA
Middle Name:
Last Name:CALCANO VILLEGAS
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 1:6241 SW 151ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2740
Mailing Address - Country:US
Mailing Address - Phone:786-370-7336
Mailing Address - Fax:
Practice Address - Street 1:14736 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1481
Practice Address - Country:US
Practice Address - Phone:305-387-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RMA # MA12083584247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other