Provider Demographics
NPI:1033602750
Name:MAYOL CALDERON, ISAMAR (MA)
Entity type:Individual
Prefix:
First Name:ISAMAR
Middle Name:
Last Name:MAYOL CALDERON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 N WARREN AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2242
Mailing Address - Country:US
Mailing Address - Phone:787-565-1270
Mailing Address - Fax:
Practice Address - Street 1:8500 FALMOUTH AVE UNIT 3106
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8760
Practice Address - Country:US
Practice Address - Phone:787-565-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA32360103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist