Healthcare Provider Details

I. General information

NPI: 1972986750
Provider Name (Legal Business Name): CALEB BARCENAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD STE 401
PHOENIX AZ
85013-4423
US

IV. Provider business mailing address

240 W THOMAS RD # 301
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3473
  • Fax: 602-406-4406
Mailing address:
  • Phone: 602-406-6238
  • Fax: 602-230-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-005802
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY-005802
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: