# BACALLAO HEALTH SERVIES,CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710118492
- **Authorized official:** JORGE J BACALLAO M.D (PRESIDENT)
- **Authorized official phone:** (786) 200-3217

## Contact information

- **Practice address:** 7601 E TREASURE DR, SUITE 1703, NORTH BAY VILLAGE, FL 33141-4391
- **Practice address phone:** (786) 200-3217
- **Mailing address:** 7601 E TREASURE DR, SUITE 1703, NORTH BAY VILLAGE, FL 33141-4391
- **Mailing address phone:** (786) 200-3217

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME 92076 | FL | Yes |

## Other

- **Enumeration date:** 07/29/2009
- **Last updated:** 07/29/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 268789500 | — | FL |