Healthcare Provider Details

I. General information

NPI: 1639002835
Provider Name (Legal Business Name): MELISSA MICHELL CALDERON LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MICHELL CALDERON

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E ELIZABETH ST
BARSTOW CA
92311-4010
US

IV. Provider business mailing address

1124 E ELIZABETH ST
BARSTOW CA
92311-4010
US

V. Phone/Fax

Practice location:
  • Phone: 602-653-1644
  • Fax:
Mailing address:
  • Phone: 602-653-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: