Provider Demographics
NPI:1851460166
Name:CALDERON, ROBERTO ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANGEL
Last Name:CALDERON
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:CONDOMINIO EL BOSQUE APT 1011
Mailing Address - Street 2:13 CAMINO LOS BAEZ
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-460-8389
Mailing Address - Fax:
Practice Address - Street 1:SANTURCE MEDICAL MALL
Practice Address - Street 2:PONCE DE LEON 1801
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-0001
Practice Address - Country:US
Practice Address - Phone:787-999-0441
Practice Address - Fax:787-792-1741
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG84832Medicare UPIN