Provider Demographics
NPI:1871872465
Name:CUCALON CALDERON, JOSE R (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:CUCALON CALDERON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:21 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1316
Mailing Address - Country:US
Mailing Address - Phone:775-982-5000
Mailing Address - Fax:
Practice Address - Street 1:745 W MOANA LN STE 260
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4991
Practice Address - Country:US
Practice Address - Phone:775-982-5437
Practice Address - Fax:775-982-8055
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL3722R208000000X
NV17322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
12750272OtherCAQH