Provider Demographics
NPI:1972118966
Name:CALDERA, CARLOS E
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:E
Last Name:CALDERA
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 1:315 221ST PL SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7592
Mailing Address - Country:US
Mailing Address - Phone:206-291-3877
Mailing Address - Fax:
Practice Address - Street 1:315 221ST PL SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7592
Practice Address - Country:US
Practice Address - Phone:206-291-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC11501171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter