Provider Demographics
NPI:1841437605
Name:CALDERON, KEVIA MARTINA (PHD)
Entity type:Individual
Prefix:
First Name:KEVIA
Middle Name:MARTINA
Last Name:CALDERON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT ROOSEVELT 531 C/ARRIGOITIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2648
Mailing Address - Country:US
Mailing Address - Phone:787-392-9990
Mailing Address - Fax:
Practice Address - Street 1:CALLE CESAR GONZALEZ
Practice Address - Street 2:#407
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3901
Practice Address - Country:US
Practice Address - Phone:787-215-9311
Practice Address - Fax:787-759-8342
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical