Provider Demographics
NPI:1861712556
Name:CALDERON-SOTO, JAIME (PHD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:CALDERON-SOTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CALLE ROBLES
Mailing Address - Street 2:OFIC. 6
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3002
Mailing Address - Country:US
Mailing Address - Phone:787-649-1846
Mailing Address - Fax:
Practice Address - Street 1:54 CALLE ROBLES
Practice Address - Street 2:OFIC. 6
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3002
Practice Address - Country:US
Practice Address - Phone:787-649-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical