Provider Demographics
NPI:1740259142
Name:DIEGO H. CALONJE M.D. PC
Entity type:Organization
Organization Name:DIEGO H. CALONJE M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST/RETINA
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:HERNANDO
Authorized Official - Last Name:CALONJE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-886-4080
Mailing Address - Street 1:1951 N WILMOT RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8000
Mailing Address - Country:US
Mailing Address - Phone:520-886-4080
Mailing Address - Fax:520-594-9122
Practice Address - Street 1:1951 N WILMOT RD
Practice Address - Street 2:SUITE 15
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-8000
Practice Address - Country:US
Practice Address - Phone:520-886-4080
Practice Address - Fax:520-594-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ567844Medicaid
G54361Medicare UPIN
AZ567844Medicaid