MEDICARE: DR. JESSIE CALDERA PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY3008	CA

General Provider Information

NPI Number	:	1497005706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSIE CALDERA PSY.D

Provider Business Mailing Address
First Line	:	2447 PACIFIC COAST HWY STE 210
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2714
Country	:	US
Telephone Number	:	310-905-3151
Fax Number	:	310-756-1225

Provider Business Practice Location Address
First Line	:	2447 PACIFIC COAST HWY STE 210
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2714
Country	:	US
Telephone Number	:	310-905-3151
Fax Number	:	310-756-1225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	01/09/2025

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