Provider Demographics
NPI:1578719613
Name:CALDERON, RAMON
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
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 1:183 ZAFIRO STREET
Mailing Address - Street 2:URB. VILLA ALEGRIA
Mailing Address - City:AGUADILLA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00603
Mailing Address - Country:UM
Mailing Address - Phone:787-891-5805
Mailing Address - Fax:787-891-5805
Practice Address - Street 1:183 CALLE ZAFIRO
Practice Address - Street 2:URB VILLA ALEGRIA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5637
Practice Address - Country:US
Practice Address - Phone:787-891-5805
Practice Address - Fax:787-891-5805
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0662776146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR59376Medicare PIN