Provider Demographics
NPI:1659165694
Name:ICALZADA LLC
Entity type:Organization
Organization Name:ICALZADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALZADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-550-1715
Mailing Address - Street 1:3604 INDIAN CHERRY PL
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-0649
Mailing Address - Country:US
Mailing Address - Phone:817-301-6494
Mailing Address - Fax:844-522-0357
Practice Address - Street 1:1000 HERITAGE CENTER CIR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4463
Practice Address - Country:US
Practice Address - Phone:512-550-1715
Practice Address - Fax:844-522-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty