Provider Demographics
NPI:1386667228
Name:CALDERON-ABBO, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CALDERON-ABBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 POYDRAS ST
Mailing Address - Street 2:SUITE1640
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1221
Mailing Address - Country:US
Mailing Address - Phone:504-412-1835
Mailing Address - Fax:
Practice Address - Street 1:210 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5735
Practice Address - Country:US
Practice Address - Phone:504-897-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14816R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1144231Medicaid
LA1144231Medicaid
LA4E852F669Medicare PIN
H09296Medicare UPIN
LAP00033562Medicare PIN