Provider Demographics
NPI:1932414562
Name:CALDERON-AGUIRRE, JUAN (MSSA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:CALDERON-AGUIRRE
Suffix:
Gender:M
Credentials:MSSA
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:MANUEL
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSA
Mailing Address - Street 1:4643 WILSON AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3577
Mailing Address - Country:US
Mailing Address - Phone:619-808-4477
Mailing Address - Fax:
Practice Address - Street 1:4080 CENTRE ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2655
Practice Address - Country:US
Practice Address - Phone:619-955-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932414562OtherNPPES