Provider Demographics
NPI:1134789407
Name:MEDINA CALDERON, ALEXANDRA (MSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MEDINA CALDERON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RES ESPINOSA
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-6035
Mailing Address - Country:US
Mailing Address - Phone:787-629-7503
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO PLAZA DEL CONDADO
Practice Address - Street 2:62-64 CALLE CONDADO
Practice Address - City:CONDADO
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-725-6000
Practice Address - Fax:787-722-0711
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11969104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty