Provider Demographics
NPI:1912590142
Name:CALDERON SALAS, ROXANNA JUDITH
Entity Type:Individual
Prefix:MRS
First Name:ROXANNA
Middle Name:JUDITH
Last Name:CALDERON SALAS
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:CALLE 522 BLOQ. 192 #38 URB. VILLA CAROLINA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-459-7189
Mailing Address - Fax:
Practice Address - Street 1:CALLE 522 BLOQ. 192 #38 URB. VILLA CAROLINA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-459-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6624103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6624OtherJUNTA EXAMINADORA DE PSICOLOGIA DE PR