1902651011 NPI number — RAMON TICO CALZADA M.D.

Table of content: RAMON TICO CALZADA M.D. (NPI 1902651011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902651011 NPI number — RAMON TICO CALZADA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TICO CALZADA
Provider First Name:
RAMON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902651011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CONDOMINIO CERRO ALTO 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESCAZU
Provider Business Mailing Address State Name:
SAN JOSE
Provider Business Mailing Address Postal Code:
10203
Provider Business Mailing Address Country Code:
CR
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79-01 BROADWAY ELMHURST HOSP CTR-MOUNT SINAI
Provider Second Line Business Practice Location Address:
RM D6-04
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-334-3437
Provider Business Practice Location Address Fax Number:
718-334-4904
Provider Enumeration Date:
04/22/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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