Provider Demographics
NPI:1366189698
Name:CALDERA, RENISA
Entity type:Individual
Prefix:
First Name:RENISA
Middle Name:
Last Name:CALDERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 W LAKE MEAD PKWY STE 1220
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7046
Mailing Address - Country:US
Mailing Address - Phone:702-566-2433
Mailing Address - Fax:
Practice Address - Street 1:3240 LAS VEGAS BLVD N APT 161
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-1540
Practice Address - Country:US
Practice Address - Phone:725-266-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant