Healthcare Provider Details

I. General information

NPI: 1700575735
Provider Name (Legal Business Name): ALEXANDRA ISABEL CALDERON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL PEDIATRICO UNIVERSITARIO CARR. 22 BO. MONACILLOS, CENTRO MEDICO
RIO PIEDRAS PR
00935-5067
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-0333
  • Fax:
Mailing address:
  • Phone: 787-474-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16628
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: