Healthcare Provider Details

I. General information

NPI: 1992816730
Provider Name (Legal Business Name): FERNANDO CALDERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 CALLE ALDA
SAN JUAN PR
00926-2709
US

IV. Provider business mailing address

1450 AVE ASHFORD APT 7A
SAN JUAN PR
00907-1537
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-9797
  • Fax: 787-622-9888
Mailing address:
  • Phone: 787-721-6557
  • Fax: 787-765-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number11876
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: