Provider Demographics
NPI:1104693589
Name:GONZALEZ CALZADA, PEDRO NELSON
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:NELSON
Last Name:GONZALEZ CALZADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 W 6TH CT APT 3
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2170
Mailing Address - Country:US
Mailing Address - Phone:786-838-3809
Mailing Address - Fax:
Practice Address - Street 1:2435 W 6TH CT APT 3
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2170
Practice Address - Country:US
Practice Address - Phone:786-838-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-314634106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician