Provider Demographics
NPI:1275709925
Name:CALDERA, RAQUEL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:
Last Name:CALDERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:SALDIVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-8500
Mailing Address - Fax:
Practice Address - Street 1:2151 N HARBOR BLVD STE 3100
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3825
Practice Address - Country:US
Practice Address - Phone:714-446-5830
Practice Address - Fax:714-992-3037
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19467363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical