Healthcare Provider Details

I. General information

NPI: 1346820610
Provider Name (Legal Business Name): CARLOS L CALDERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE STE 302
LONG BEACH CA
90813-3295
US

IV. Provider business mailing address

611 S KINGSLEY DR
LOS ANGELES CA
90005-2319
US

V. Phone/Fax

Practice location:
  • Phone: 562-247-7740
  • Fax: 562-432-5122
Mailing address:
  • Phone: 213-201-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA187500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: