Healthcare Provider Details

I. General information

NPI: 1700514031
Provider Name (Legal Business Name): ALLEN K CALDERON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 WESTWOOD DR STE 20
LAS VEGAS NV
89109-1033
US

IV. Provider business mailing address

6515 FEATHER PEAK ST
N LAS VEGAS NV
89084-2056
US

V. Phone/Fax

Practice location:
  • Phone: 702-888-1399
  • Fax:
Mailing address:
  • Phone: 702-403-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: