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General NPI Number Information
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NPI Number | 1396441986
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Entity Type | Individual
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Provider Name | JORGE RUBEN CALDERAS NP
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Gender | Male
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 3811 BEDFORD CANYON RD STE 101-104
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City | CORONA
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State | CA
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Zip | 92883-0789
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Country | US
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Telephone | 951-444-0467
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 DRIFTWOOD ST
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City | CORONA
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State | CA
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Zip | 92878-3602
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Country | US
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Telephone | 951-227-6877
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95024097
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License Number State | CA
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