Provider Demographics
NPI:1710389606
Name:CALERO PAGAN, KEISHLA
Entity Type:Individual
Prefix:
First Name:KEISHLA
Middle Name:
Last Name:CALERO PAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00794
Mailing Address - Country:UM
Mailing Address - Phone:787-438-8291
Mailing Address - Fax:787-730-3446
Practice Address - Street 1:RR 14 BOX 5334
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9711
Practice Address - Country:US
Practice Address - Phone:787-438-8291
Practice Address - Fax:787-730-3446
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR38324171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator