Provider Demographics
NPI:1265645295
Name:URIAH CALDERA
Entity type:Organization
Organization Name:URIAH CALDERA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:URIAH
Authorized Official - Middle Name:BLUE
Authorized Official - Last Name:CALDERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-325-5394
Mailing Address - Street 1:375 ANTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3321
Mailing Address - Country:US
Mailing Address - Phone:210-325-5394
Mailing Address - Fax:
Practice Address - Street 1:2406 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-3124
Practice Address - Country:US
Practice Address - Phone:210-229-9000
Practice Address - Fax:210-229-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0095551332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095551OtherMULTIPLE PRODUCT LICENSE
TX193666801Medicaid
TX193666801Medicaid