Provider Demographics
NPI:1568295954
Name:CALDEJON, JOHN RENDELL SAULOG
Entity type:Individual
Prefix:
First Name:JOHN RENDELL
Middle Name:SAULOG
Last Name:CALDEJON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9198 DESERT HEAT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-6218
Mailing Address - Country:US
Mailing Address - Phone:702-688-0022
Mailing Address - Fax:
Practice Address - Street 1:9198 DESERT HEAT AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-6218
Practice Address - Country:US
Practice Address - Phone:702-688-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN67997163W00000X, 163WP0808X
NV884594363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health