Individual
MR. JUAN LUIS CALDERON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
STL, LMT
Contact information
Practice address
6002 WASHINGTON ST, WEST NEW YORK, NJ 07093-1420
(201) 401-4204
Mailing address
PO BOX 443, WEST NEW YORK, NJ 07093-0443
(201) 401-4204
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
18KT01274200
NJ
Other
Enumeration date
06/14/2018
Last updated
06/14/2018
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