Individual
KENNET CALDERON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2117 VINE CT, FAIRFIELD, CA 94533-5881
(707) 333-3255
Mailing address
PO BOX 898, DIXON, CA 95620-0898
(707) 333-3255
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
12000733
CA
Other
Enumeration date
10/04/2012
Last updated
10/04/2012
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