Provider Demographics
NPI:1235239658
Name:CUBANO CALDERON, GERARDO AUGUSTO (PHD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:AUGUSTO
Last Name:CUBANO CALDERON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 CALLE GONZALO BERCEO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6918
Mailing Address - Country:US
Mailing Address - Phone:787-292-4761
Mailing Address - Fax:787-783-0686
Practice Address - Street 1:D12 CALLE BUEN SAMARITANO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2025
Practice Address - Country:US
Practice Address - Phone:787-783-0610
Practice Address - Fax:787-783-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical