Provider Demographics
NPI:1619509213
Name:CALERO, ELISMARIE (MS-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELISMARIE
Middle Name:
Last Name:CALERO
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TABONUCO ST.
Mailing Address - Street 2:VISTAS DE RIO GRANDE 2
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-8570
Mailing Address - Country:US
Mailing Address - Phone:787-344-4104
Mailing Address - Fax:
Practice Address - Street 1:450 TABONUCO ST.
Practice Address - Street 2:VISTAS DE RIO GRANDE 2
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-8570
Practice Address - Country:US
Practice Address - Phone:787-344-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty