Provider Demographics
NPI:1326835117
Name:CALDERON, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:CALDERON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12647 SUMAC DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-4606
Mailing Address - Country:US
Mailing Address - Phone:760-464-8445
Mailing Address - Fax:
Practice Address - Street 1:44100 MONTEREY AVE STE 216G
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2718
Practice Address - Country:US
Practice Address - Phone:760-464-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86039225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist