1932414562 NPI number — MR. JUAN CALDERON-AGUIRRE M.S.S.A

Table of content: MICHELE LYNN WELKER NP (NPI 1740941434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932414562 NPI number — MR. JUAN CALDERON-AGUIRRE M.S.S.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDERON-AGUIRRE
Provider First Name:
JUAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.S.A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALDERON
Provider Other First Name:
JUAN
Provider Other Middle Name:
MANUEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.S.A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932414562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4643 WILSON AVE APT 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92116-3577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-808-4477
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4080 CENTRE ST STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-955-9902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1932414562 . This is a "NPPES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".