Provider Demographics
NPI:1013261692
Name:CALDERON, OTILIA
Entity Type:Individual
Prefix:MS
First Name:OTILIA
Middle Name:
Last Name:CALDERON
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:CARR 567 INT 5567
Mailing Address - Street 2:VAGA 1
Mailing Address - City:MOROVIS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00687
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 02 BOX 6490
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00687
Practice Address - Country:UM
Practice Address - Phone:787-367-3417
Practice Address - Fax:787-855-3225
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5940183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician