Provider Demographics
NPI:1255077400
Name:CALDERON, MARIA CHARISSA (RN)
Entity type:Individual
Prefix:
First Name:MARIA CHARISSA
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARIA CHARISSA
Other - Middle Name:CALDERON
Other - Last Name:RULE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21984 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6438
Mailing Address - Country:US
Mailing Address - Phone:510-688-7585
Mailing Address - Fax:
Practice Address - Street 1:21984 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6438
Practice Address - Country:US
Practice Address - Phone:510-688-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95245208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse