MEDICARE: ROBERTO CALDERON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NM

General Provider Information

NPI Number	:	1659646347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO CALDERON

Provider Business Mailing Address
First Line	:	100 W GRIGGS AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1234
Country	:	US
Telephone Number	:	575-647-2800
Fax Number	:	575-647-2898

Provider Business Practice Location Address
First Line	:	118 S DOWNTOWN MALL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1218
Country	:	US
Telephone Number	:	575-647-2877
Fax Number	:	575-647-2898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	03/14/2012

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Directions to “ ROBERTO CALDERON ” Practice Location

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