Healthcare Provider Details

I. General information

NPI: 1457869661
Provider Name (Legal Business Name): ARASELI CALDERON GARCIA SUDCC 7703
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 S 38TH ST
SAN DIEGO CA
92113-3210
US

IV. Provider business mailing address

PO BOX 3815
CHULA VISTA CA
91909-3815
US

V. Phone/Fax

Practice location:
  • Phone: 619-262-4002
  • Fax:
Mailing address:
  • Phone: 559-363-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: