Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME 50220 | FL |
NPI | 1033169222 |
---|---|
Provider Name | Freddy J Caldera |
First Address | Miami Springs, FL 33166-6036 |
Second Address | Miami Springs, FL 33166-6036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 12/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061642700 | (05) | FL |
650127333 | TAX IDENTIFICATION NUMBER (01) | FL |
D061004 | (02) | FL |