Provider Demographics
NPI:1780209064
Name:CALZADA, JOEL MARIO
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:MARIO
Last Name:CALZADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:MARIO
Other - Last Name:CALZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2415 REYNOLDS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:N. LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030
Mailing Address - Country:US
Mailing Address - Phone:702-822-1253
Mailing Address - Fax:702-906-1999
Practice Address - Street 1:2415 REYNOLDS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:702-822-1253
Practice Address - Fax:702-906-1999
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant