Basic Information
| Provider Information | |||||||||
| NPI: | 1063868537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALABRESE | ||||||||
| FirstName: | MARIELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4988 PELICAN MNR | ||||||||
| Address2: | |||||||||
| City: | COCONUT CREEK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330732422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7544239097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 W CYPRESS CREEK RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333091900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2016 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | FL | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.