Provider Demographics
NPI:1124484027
Name:CALDERON, DESSIRE (BA)
Entity type:Individual
Prefix:
First Name:DESSIRE
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N RAMONA BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-2567
Mailing Address - Country:US
Mailing Address - Phone:951-487-2674
Mailing Address - Fax:
Practice Address - Street 1:950 N RAMONA BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-2567
Practice Address - Country:US
Practice Address - Phone:951-487-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator