Provider Demographics
NPI:1255002598
Name:CALDERON, LUIS SR
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:CALDERON
Suffix:SR
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 1:54 BERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9426
Mailing Address - Country:US
Mailing Address - Phone:787-307-6694
Mailing Address - Fax:
Practice Address - Street 1:54 BERLIN AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-9426
Practice Address - Country:US
Practice Address - Phone:787-307-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty