Provider Demographics
NPI:1275130205
Name:CALDERON, LUCY
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11738
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-2438
Mailing Address - Country:US
Mailing Address - Phone:509-945-5796
Mailing Address - Fax:
Practice Address - Street 1:1317 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5410
Practice Address - Country:US
Practice Address - Phone:509-945-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2022-09-29
Deactivation Date:2020-12-06
Deactivation Code:
Reactivation Date:2022-09-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter