Provider Demographics
NPI:1174285092
Name:CALDERON, DANIEL (SO-ATP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:SO-ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 ALIAMANU DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-7089
Mailing Address - Country:US
Mailing Address - Phone:201-888-4733
Mailing Address - Fax:
Practice Address - Street 1:1253 MAKALAPA GATE RD BLDG 1407
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860-4479
Practice Address - Country:US
Practice Address - Phone:201-888-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1840660146N00000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty