Basic Information
Provider Information
NPI: 1003294042
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALLE
FirstName: SUSANA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P O BOX 4439
Address2:  
City: HOUSTON
State: TX
PostalCode: 772104439
CountryCode: US
TelephoneNumber: 7137922991
FaxNumber:  
Practice Location
Address1: 1515 HOLCOMBE BLVD
Address2:  
City: HOUSTON
State: TX
PostalCode: 770304000
CountryCode: US
TelephoneNumber: 7137926161
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2015
LastUpdateDate: 03/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085N0700X46824TXN Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology
2085R0202X46824TXY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
8LQ05801TXBCBSOTHER
40217270105TX MEDICAID
40217270201TXCSHCN (MEDICAID)OTHER


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