Provider Demographics
NPI:1174046379
Name:CALDERON, CARLOS ALEJANDRO
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALEJANDRO
Last Name:CALDERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 E 4TH AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3238
Mailing Address - Country:US
Mailing Address - Phone:786-972-7002
Mailing Address - Fax:
Practice Address - Street 1:2981 E 4TH AVE APT 12
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3238
Practice Address - Country:US
Practice Address - Phone:786-972-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician