Provider Demographics
NPI:1154316099
Name:CALDERONE, ROCCO RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:RICHARD
Last Name:CALDERONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2486 PONDEROSA DRIVE NORTH D 114
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2469
Mailing Address - Country:US
Mailing Address - Phone:805-484-2783
Mailing Address - Fax:805-987-8519
Practice Address - Street 1:2486 PONDEROSA DRIVE NORTH D 114
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2469
Practice Address - Country:US
Practice Address - Phone:805-484-2783
Practice Address - Fax:805-987-8519
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78977207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF87246Medicare UPIN
CABT942AMedicare PIN
CA1019490001Medicare NSC
CACB273671Medicare PIN