MEDICARE: ALEXANDER CALDERON ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1801303110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER CALDERON ATC

Provider Business Mailing Address
First Line	:	3313 PARK VISTA DR
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3376
Country	:	US
Telephone Number	:	818-434-7110
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 NORTH FARING ROAD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-3525
Country	:	US
Telephone Number	:	310-288-3312
Fax Number	:

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

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	01/08/2018

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