Provider Demographics
NPI:1003162736
Name:CALZADO, JIMMY MAGGAY (CNP)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:MAGGAY
Last Name:CALZADO
Suffix:
Gender:M
Credentials:CNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1350 JACKIE RD SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1519
Mailing Address - Country:US
Mailing Address - Phone:505-515-3982
Mailing Address - Fax:505-792-6060
Practice Address - Street 1:1350 JACKIE RD SE
Practice Address - Street 2:SUITE 104
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1519
Practice Address - Country:US
Practice Address - Phone:505-515-3982
Practice Address - Fax:505-792-6060
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-01999363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM08453781Medicaid