Provider Demographics
NPI:1942030655
Name:CALDERON, LIDIA R
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:R
Last Name:CALDERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S SATICOY AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1853
Mailing Address - Country:US
Mailing Address - Phone:805-901-6987
Mailing Address - Fax:
Practice Address - Street 1:828 W VENTURA ST STE 240
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1882
Practice Address - Country:US
Practice Address - Phone:805-524-8660
Practice Address - Fax:805-524-8655
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator