Provider Demographics
NPI:1720666068
Name:CALDERON, EMILIANO SESAI
Entity type:Individual
Prefix:MR
First Name:EMILIANO
Middle Name:SESAI
Last Name:CALDERON
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 1:5240 STONE MOUNTAIN PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3794
Mailing Address - Country:US
Mailing Address - Phone:505-417-5343
Mailing Address - Fax:
Practice Address - Street 1:5240 STONE MOUNTAIN PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3794
Practice Address - Country:US
Practice Address - Phone:505-417-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMHB2021363578332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies