Healthcare Provider Details

I. General information

NPI: 1871488080
Provider Name (Legal Business Name): JOSHUA CALDERON AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 S BENTLEY AVE APT 20
LOS ANGELES CA
90025-4325
US

IV. Provider business mailing address

1835 S BENTLEY AVE APT 20
LOS ANGELES CA
90025-4325
US

V. Phone/Fax

Practice location:
  • Phone: 310-409-8717
  • Fax:
Mailing address:
  • Phone: 310-409-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number153202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: