Provider Demographics
NPI:1043721749
Name:RENO, CALANDRIA
Entity Type:Individual
Prefix:
First Name:CALANDRIA
Middle Name:
Last Name:RENO
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:PO BOX 2243
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-2243
Mailing Address - Country:US
Mailing Address - Phone:575-527-5482
Mailing Address - Fax:575-652-4243
Practice Address - Street 1:999 W AMADOR AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2739
Practice Address - Country:US
Practice Address - Phone:575-527-5482
Practice Address - Fax:575-652-4243
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2017-0071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42172861Medicaid
NM1S2676OtherMEDICARE