Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME43325 | FL |
NPI | 1003891029 |
---|---|
Provider Name | Dr. Gustavo Calleja |
First Address | Miami, FL 33173-5426 |
Second Address | Miami, FL 33173-5426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 18/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BC1705308 | DEA (01) | FL |
C61176 | (02) | FL |