| Callisia Health Group Inc | |
|
11430 N Kendall Dr Ste D309 Miami FL 33176-1032 | |
| (305) 898-0849 | |
| (305) 402-5884 |
| Full Name | Callisia Health Group Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11430 N Kendall Dr Ste D309, Miami, Florida |
| Authorized Official Name and Position | Adriana Gonzalez (OWNER) |
| Authorized Official Contact | 3058980849 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Callisia Health Group Inc 11430 N Kendall Dr Ste D309 Miami FL 33176-1032 Ph: (305) 898-0849 | Callisia Health Group Inc 11430 N Kendall Dr Ste D309 Miami FL 33176-1032 Ph: (305) 898-0849 |
| NPI Number | 1528685187 |
|---|---|
| Provider Enumeration Date | 06/30/2020 |
| Last Update Date | 06/01/2023 |
| Medicare PECOS PAC ID | 0840616066 |
|---|---|
| Medicare Enrollment ID | O20200819001177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528685187 | NPI | - | NPPES |
| 107863300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Adriana Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588191308 PECOS PAC ID: 3577697259 Enrollment ID: I20180221002609 |
| Provider Name | Brian Villa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861843906 PECOS PAC ID: 2769812833 Enrollment ID: I20200414002044 |
| Provider Name | Lizet Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215485354 PECOS PAC ID: 9931487857 Enrollment ID: I20201118001226 |
| Provider Name | Karin S Drouet Tutiven |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467032359 PECOS PAC ID: 4587060421 Enrollment ID: I20210901001687 |
| Provider Name | Natalia Azucena |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164022737 PECOS PAC ID: 1456738517 Enrollment ID: I20220512000157 |
| Provider Name | Ileana Morcillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164032553 PECOS PAC ID: 2860874351 Enrollment ID: I20220730000337 |
| Provider Name | Alian Hernandez Lopez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1710333596 PECOS PAC ID: 1355778184 Enrollment ID: I20220827000475 |
| Provider Name | Ernesto Dominguez Macias |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235749433 PECOS PAC ID: 9133586340 Enrollment ID: I20230602002070 |
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