Healthcare Provider Details

I. General information

NPI: 1316877061
Provider Name (Legal Business Name): BIANKA JOSE CALDERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15837 PAUL VEGA MD DR
HAMMOND LA
70403-1495
US

IV. Provider business mailing address

3320 CLAIRE AVE
GRETNA LA
70053-7520
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-2700
  • Fax:
Mailing address:
  • Phone: 504-405-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number202829
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: