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NPI Code Detail

MEDICARE: STEPHANY CALDERON I

MEDICARE:   STEPHANY  CALDERON I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1588194146
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANY CALDERON I
Provider Business Mailing Address
First Line : 1420 CARLISLE BLVD NE STE 100
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-5662
Country : US
Telephone Number : 818-241-6780
Fax Number :
Provider Business Practice Location Address
First Line : 3512 ROSS AVE SE APT A
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-1654
Country : US
Telephone Number : 505-385-5260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2017
Last Update Date : 08/11/2021

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Directions to “ STEPHANY CALDERON I ” Practice Location

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