Provider Demographics
NPI:1588393755
Name:CALDERA, JUAN RAPHAEL (PHD, D(ABMM))
Entity type:Individual
Prefix:DR
First Name:JUAN RAPHAEL
Middle Name:
Last Name:CALDERA
Suffix:
Gender:M
Credentials:PHD, D(ABMM)
Other - Prefix:DR
Other - First Name:JR
Other - Middle Name:
Other - Last Name:CALDERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, D(ABMM)
Mailing Address - Street 1:7970 MISSION CENTER CT UNIT L
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1463
Mailing Address - Country:US
Mailing Address - Phone:626-864-3517
Mailing Address - Fax:
Practice Address - Street 1:33608 ORTEGA HWY
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2042
Practice Address - Country:US
Practice Address - Phone:949-728-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246QM0900X
CAMTA00044966246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology