Provider Demographics
NPI:1255814000
Name:CALDERON AVILES, LORAINE
Entity type:Individual
Prefix:MRS
First Name:LORAINE
Middle Name:
Last Name:CALDERON AVILES
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 1:68 CALLE E
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5126
Mailing Address - Country:US
Mailing Address - Phone:787-360-6682
Mailing Address - Fax:
Practice Address - Street 1:1503 CALLE PROF AUGUSTO RODRIGUEZ CONDOMINIO ASIA
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-497-0800
Practice Address - Fax:787-982-6464
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR246YC3301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YC3301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Hospital Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$Medicaid