Healthcare Provider Details

I. General information

NPI: 1871872465
Provider Name (Legal Business Name): JOSE R CUCALON CALDERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W MOANA LN STE 260
RENO NV
89509-4991
US

IV. Provider business mailing address

21 LOCUST ST
RENO NV
89502-1316
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5437
  • Fax: 775-982-8055
Mailing address:
  • Phone: 775-982-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3722R
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17322
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: