Provider Demographics
NPI:1407197395
Name:CALERO BAQUERIZO, FERNANDO JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JAVIER
Last Name:CALERO BAQUERIZO
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 1:78 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4417
Mailing Address - Country:US
Mailing Address - Phone:479-484-5600
Mailing Address - Fax:
Practice Address - Street 1:78 BAKER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4417
Practice Address - Country:US
Practice Address - Phone:401-781-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-03
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD17603207R00000X, 207R00000X
ARE-9091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD17603OtherRI LICENSE