Provider Demographics
NPI:1326300658
Name:CALDERON, RAUL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:RAUL
Other - Middle Name:
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:304 N RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4639
Mailing Address - Country:US
Mailing Address - Phone:575-578-0069
Mailing Address - Fax:575-578-0124
Practice Address - Street 1:304 N RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4639
Practice Address - Country:US
Practice Address - Phone:575-578-0069
Practice Address - Fax:575-578-0124
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2898261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine