Provider Demographics
NPI:1740405125
Name:CALDERON, ELVIS E
Entity Type:Individual
Prefix:MR
First Name:ELVIS
Middle Name:E
Last Name: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 1:7720 SW 163RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3448
Mailing Address - Country:US
Mailing Address - Phone:305-510-4279
Mailing Address - Fax:
Practice Address - Street 1:7705 NW 48TH ST
Practice Address - Street 2:SUIT 120
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5454
Practice Address - Country:US
Practice Address - Phone:305-510-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist