Provider Demographics
NPI:1265914238
Name:CALDERON, AMBROSIO JR
Entity type:Individual
Prefix:
First Name:AMBROSIO
Middle Name:
Last Name:CALDERON
Suffix:JR
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 1:3804 ESPEJO MOLINA RD
Mailing Address - Street 2:
Mailing Address - City:EL CENIZO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-8036
Mailing Address - Country:US
Mailing Address - Phone:956-645-4744
Mailing Address - Fax:
Practice Address - Street 1:3804 ESPEJO MOLINA RD
Practice Address - Street 2:
Practice Address - City:EL CENIZO
Practice Address - State:TX
Practice Address - Zip Code:78046-8036
Practice Address - Country:US
Practice Address - Phone:956-645-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily