MEDICARE: WALTER A. CALDERON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist		NM

General Provider Information

NPI Number	:	1063369478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER A. CALDERON

Provider Business Mailing Address
First Line	:	5880 SANDOVAL DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5152
Country	:	US
Telephone Number	:	505-353-7498
Fax Number	:

Provider Business Practice Location Address
First Line	:	5880 SANDOVAL DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5152
Country	:	US
Telephone Number	:	505-353-7498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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