Provider Demographics
NPI:1194090738
Name:CALDERON, LUIS E (CRTS)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:E
Last Name:CALDERON
Suffix:
Gender:M
Credentials:CRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 E ELLER AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-3304
Mailing Address - Country:US
Mailing Address - Phone:956-821-2540
Mailing Address - Fax:956-283-7324
Practice Address - Street 1:517 S NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-2645
Practice Address - Country:US
Practice Address - Phone:956-283-7333
Practice Address - Fax:956-283-7324
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies