Healthcare Provider Details

I. General information

NPI: 1245156058
Provider Name (Legal Business Name): DIANA CRYSTAL CALDERON-SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N 45TH ST
SEATTLE WA
98103-6401
US

IV. Provider business mailing address

1501 NW 56TH ST APT 542
SEATTLE WA
98107-5282
US

V. Phone/Fax

Practice location:
  • Phone: 509-330-6463
  • Fax:
Mailing address:
  • Phone: 509-330-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: