Healthcare Provider Details

I. General information

NPI: 1801694518
Provider Name (Legal Business Name): CRISTINA Y CALDERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

IV. Provider business mailing address

2642 CALLE PRIMAVERA
SANTA FE NM
87505-5555
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-4985
  • Fax:
Mailing address:
  • Phone: 915-740-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1492
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: