Provider Demographics
NPI:1063826774
Name:CALDERON MOULTRIE, NATALIE (AUD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:CALDERON MOULTRIE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:16940 SLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7566
Mailing Address - Country:US
Mailing Address - Phone:909-854-8569
Mailing Address - Fax:
Practice Address - Street 1:16940 SLOVER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7566
Practice Address - Country:US
Practice Address - Phone:909-854-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2959231H00000X
CAHA7886237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist