Healthcare Provider Details

I. General information

NPI: 1023883188
Provider Name (Legal Business Name): MR. WALTER H CALDERON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 12/31/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 STARBUCK ST APT M206
FULLERTON CA
92833-5709
US

IV. Provider business mailing address

1001 STARBUCK ST APT M206
FULLERTON CA
92833-5709
US

V. Phone/Fax

Practice location:
  • Phone: 949-891-3455
  • Fax:
Mailing address:
  • Phone: 949-891-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberY3313761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: