1235239658 NPI number — GERARDO AUGUSTO CUBANO CALDERON PH.D

Table of content: GERARDO AUGUSTO CUBANO CALDERON PH.D (NPI 1235239658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235239658 NPI number — GERARDO AUGUSTO CUBANO CALDERON PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUBANO CALDERON
Provider First Name:
GERARDO
Provider Middle Name:
AUGUSTO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235239658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 CALLE GONZALO BERCEO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-292-4761
Provider Business Mailing Address Fax Number:
787-783-0686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
D12 CALLE BUEN SAMARITANO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00966-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-783-0610
Provider Business Practice Location Address Fax Number:
787-783-0686
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1407 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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