Healthcare Provider Details

I. General information

NPI: 1982548541
Provider Name (Legal Business Name): ALAN CALDERON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17727 E CYPRESS ST
COVINA CA
91722-2634
US

IV. Provider business mailing address

17727 E CYPRESS ST
COVINA CA
91722-2634
US

V. Phone/Fax

Practice location:
  • Phone: 626-967-2677
  • Fax: 626-858-4923
Mailing address:
  • Phone: 626-967-2677
  • Fax: 626-858-4923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1434080326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: