Provider Demographics
NPI:1174622682
Name:DE LA CALLE, GILDA M (MD)
Entity type:Individual
Prefix:
First Name:GILDA
Middle Name:M
Last Name:DE LA CALLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10775 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7043
Mailing Address - Country:US
Mailing Address - Phone:786-360-4219
Mailing Address - Fax:786-360-4217
Practice Address - Street 1:1435 W 49TH PL
Practice Address - Street 2:SUITE 400B
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3197
Practice Address - Country:US
Practice Address - Phone:305-823-5730
Practice Address - Fax:305-823-5732
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90679208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME90679OtherSTATE MEDICAL LICENSE
FL270053100Medicaid
FLU3489ZMedicare PIN
FLI19434Medicare UPIN