Provider Demographics
NPI:1598582637
Name:CALDERON, MICHAEL JR (EPC, CPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CALDERON
Suffix:JR
Gender:M
Credentials:EPC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CODY RD
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4707
Mailing Address - Country:US
Mailing Address - Phone:575-694-5062
Mailing Address - Fax:
Practice Address - Street 1:411 CODY RD
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4707
Practice Address - Country:US
Practice Address - Phone:575-694-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist