Provider Demographics
NPI:1891717898
Name:CALOBRISI, STELLA DIVINA (MD)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:DIVINA
Last Name:CALOBRISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 NW 13TH ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2342
Mailing Address - Country:US
Mailing Address - Phone:561-393-0300
Mailing Address - Fax:561-393-0048
Practice Address - Street 1:880 NW 13TH ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2342
Practice Address - Country:US
Practice Address - Phone:561-393-0300
Practice Address - Fax:561-393-0048
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78997174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78997OtherLICENSE
FLBC/BS FLOther49480
FL650962920OtherTAX ID
PA115370OtherPENN BLUE SHIELD
FLBC4483816OtherDEA
FLBC/BS FLOther49480
FLK1433Medicare ID - Type UnspecifiedGROUP
FL49480ZMedicare ID - Type UnspecifiedINDIVIDUAL