Healthcare Provider Details

I. General information

NPI: 1598582637
Provider Name (Legal Business Name): MICHAEL CALDERON JR. EPC, NBC-HWC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CODY RD
DEMING NM
88030-4707
US

IV. Provider business mailing address

411 CODY RD
DEMING NM
88030-4707
US

V. Phone/Fax

Practice location:
  • Phone: 575-694-5062
  • Fax:
Mailing address:
  • Phone: 575-694-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: