Provider Demographics
NPI:1114608478
Name:CASCO CALDERON, ALFREDO CESAR
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:CESAR
Last Name:CASCO 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 1:255 OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3641
Mailing Address - Country:US
Mailing Address - Phone:218-576-3788
Mailing Address - Fax:
Practice Address - Street 1:255 OTTAWA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3641
Practice Address - Country:US
Practice Address - Phone:218-576-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker