Healthcare Provider Details

I. General information

NPI: 1174487755
Provider Name (Legal Business Name): ALVIN PAUL CALDERON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

2501 LYNNFIELD CT
CHESAPEAKE VA
23323-7012
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-8000
  • Fax:
Mailing address:
  • Phone: 757-812-4541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001322213
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: