Healthcare Provider Details

I. General information

NPI: 1548985393
Provider Name (Legal Business Name): MISS PERSEPHAINE CALDERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date: 06/15/2023
Reactivation Date: 06/29/2023

III. Provider practice location address

795 WILLOW RD
MENLO PARK CA
94025-2539
US

IV. Provider business mailing address

795 WILLOW RD
MENLO PARK CA
94025-2539
US

V. Phone/Fax

Practice location:
  • Phone: 650-614-9997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031897
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: