Provider Demographics
NPI:1770172678
Name:CALDERON REYES, JOSE YONI
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:YONI
Last Name:CALDERON REYES
Suffix:
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:PO BOX 2547
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0042
Mailing Address - Country:US
Mailing Address - Phone:256-202-7854
Mailing Address - Fax:
Practice Address - Street 1:130 BREEDWELL RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35962-5552
Practice Address - Country:US
Practice Address - Phone:256-202-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program