Organization
BACALLAO HEALTH SERVIES,CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE J BACALLAO M.D (PRESIDENT)
(786) 200-3217
Entity
Organization
Contact information
Practice address
7601 E TREASURE DR, SUITE 1703, NORTH BAY VILLAGE, FL 33141-4391
(786) 200-3217
Mailing address
7601 E TREASURE DR, SUITE 1703, NORTH BAY VILLAGE, FL 33141-4391
(786) 200-3217
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME 92076
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268789500
—
FL
Enumeration date
07/29/2009
Last updated
07/29/2009
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