MEDICARE: STEPHANY CALDERON I

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1588194146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANY CALDERON I

Provider Business Mailing Address
First Line	:	1420 CARLISLE BLVD NE STE 100
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5662
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	3512 ROSS AVE SE APT A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-1654
Country	:	US
Telephone Number	:	505-385-5260
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	08/11/2021

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Directions to “ STEPHANY CALDERON I ” Practice Location

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