Healthcare Provider Details

I. General information

NPI: 1568949840
Provider Name (Legal Business Name): ERICA VEGA CALOCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 NORTH WHITE ROAD
SAN JOSE CA
95127
US

IV. Provider business mailing address

3406 GROSSMONT DRIVE
SAN JOSE CA
95132
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-6848
  • Fax:
Mailing address:
  • Phone: 408-561-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: