Provider Demographics
NPI:1972131241
Name:CALA BALMASEDA, GUIANELLA ESTHER
Entity Type:Individual
Prefix:
First Name:GUIANELLA
Middle Name:ESTHER
Last Name:CALA BALMASEDA
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 1:8912 W FLAGLER ST APT 216
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3943
Mailing Address - Country:US
Mailing Address - Phone:786-606-5116
Mailing Address - Fax:
Practice Address - Street 1:564 SW 42ND AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1962
Practice Address - Country:US
Practice Address - Phone:305-701-1932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN273631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program