Provider Demographics
NPI:1760217616
Name:CALDERON AGUILAR, JOSE ANTONIO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:CALDERON AGUILAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13892 SW 46TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7904
Mailing Address - Country:US
Mailing Address - Phone:305-522-3517
Mailing Address - Fax:
Practice Address - Street 1:13892 SW 46TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7904
Practice Address - Country:US
Practice Address - Phone:305-522-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician