Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 27042 | OK |
N | 208600000X | Surgeon | 27042 | OK |
N | 2086S0102X | Surgical Critical Care | 132498 | FL |
Y | 2086S0120X | Pediatric Surgery | 132498 | FL |
NPI | 1245465863 |
---|---|
Provider Name | Juan Calisto |
First Address | Miami, FL 33155-4000 |
Second Address | Miami, FL 33155-4070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 17/03/2018 |