Provider Demographics
NPI:1023883188
Name:CALDERON, WALTER H
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:H
Last Name:CALDERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 STARBUCK ST APT M206
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5709
Mailing Address - Country:US
Mailing Address - Phone:949-891-3455
Mailing Address - Fax:
Practice Address - Street 1:1001 STARBUCK ST APT M206
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-5709
Practice Address - Country:US
Practice Address - Phone:949-891-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3313761172A00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver