Provider Demographics
NPI:1801303110
Name:CALDERON, ALEXANDER (ATC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 PARK VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3376
Mailing Address - Country:US
Mailing Address - Phone:818-434-7110
Mailing Address - Fax:
Practice Address - Street 1:700 NORTH FARING ROAD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-3525
Practice Address - Country:US
Practice Address - Phone:310-288-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer