Provider Demographics
NPI:1922277375
Name:LITA R. CALAGUA MD PA
Entity Type:Organization
Organization Name:LITA R. CALAGUA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CALAGUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-476-8126
Mailing Address - Street 1:10650 W STATE ROAD 84 STE 211
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4235
Mailing Address - Country:US
Mailing Address - Phone:954-476-8126
Mailing Address - Fax:954-449-8940
Practice Address - Street 1:10650 W STATE ROAD 84 STE 211
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4235
Practice Address - Country:US
Practice Address - Phone:954-476-8126
Practice Address - Fax:954-449-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME781502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263966100Medicaid
FLH13240Medicare UPIN
FLK4705Medicare PIN