Provider Demographics
NPI:1962662445
Name:CALLA SLIM SPA
Entity Type:Organization
Organization Name:CALLA SLIM SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-644-7546
Mailing Address - Street 1:444 W NEW ENGLAND AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4224
Mailing Address - Country:US
Mailing Address - Phone:407-644-7546
Mailing Address - Fax:
Practice Address - Street 1:444 W NEW ENGLAND AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4224
Practice Address - Country:US
Practice Address - Phone:407-644-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty