Healthcare Provider Details

I. General information

NPI: 1679410096
Provider Name (Legal Business Name): ELODIA ROSA CALIXTO SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. ELODIA ROSA ISMODES

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TWN CNTRY RD STE 1225
ORANGE CA
92868-4638
US

IV. Provider business mailing address

9242 PICADILLY WAY
ANAHEIM CA
92801-1446
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-2400
  • Fax:
Mailing address:
  • Phone: 657-456-9271
  • Fax: 657-456-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: