Healthcare Provider Details

I. General information

NPI: 1588393755
Provider Name (Legal Business Name): JUAN RAPHAEL CALDERA PHD, D(ABMM)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JR CALDERA PHD, D(ABMM)

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33608 ORTEGA HWY
SAN JUAN CAPISTRANO CA
92675-2042
US

IV. Provider business mailing address

7970 MISSION CENTER CT UNIT L
SAN DIEGO CA
92108-1463
US

V. Phone/Fax

Practice location:
  • Phone: 949-728-4880
  • Fax:
Mailing address:
  • Phone: 626-864-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0900X
TaxonomyMicrobiology Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberMTA00044966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: