Healthcare Provider Details

I. General information

NPI: 1235239658
Provider Name (Legal Business Name): GERARDO AUGUSTO CUBANO CALDERON PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D12 CALLE BUEN SAMARITANO
GUAYNABO PR
00966-2025
US

IV. Provider business mailing address

321 CALLE GONZALO BERCEO
SAN JUAN PR
00926-6918
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-0610
  • Fax: 787-783-0686
Mailing address:
  • Phone: 787-292-4761
  • Fax: 787-783-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1407
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: