Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 183656 | TX |
NPI | 1003306416 |
---|---|
Provider Name | Marisa Araceli Calderon |
First Address | Corpus Christi, TX 78401-3718 |
Second Address | Corpus Christi, TX 78401-3718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2018 |
Last Update Date | 11/05/2018 |