Provider Demographics
NPI:1396794459
Name:CALDERON, FABIAN T (CPO, LPO)
Entity type:Individual
Prefix:MR
First Name:FABIAN
Middle Name:T
Last Name:CALDERON
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 CASTILLO CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1848
Mailing Address - Country:US
Mailing Address - Phone:915-241-2115
Mailing Address - Fax:915-566-1485
Practice Address - Street 1:3901 MONTANA AVE STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4507
Practice Address - Country:US
Practice Address - Phone:915-566-3440
Practice Address - Fax:915-566-1485
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604174400000X, 224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No174400000XOther Service ProvidersSpecialist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist