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NPI Code Detail

MEDICARE: PHYLLIS PAMELA CALDERON CAS

MEDICARE: PHYLLIS PAMELA CALDERON CAS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1659610988
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS PAMELA CALDERON CAS
Provider Business Mailing Address
First Line : 4626 N GRAND AVE
Second Line :
City : COVINA
State : CA
Zip : 91724-2055
Country : US
Telephone Number : 626-331-5316
Fax Number : 626-332-2219
Provider Business Practice Location Address
First Line : 4626 N GRAND AVE
Second Line :
City : COVINA
State : CA
Zip : 91724-2055
Country : US
Telephone Number : 626-331-5316
Fax Number : 626-332-2219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2013
Last Update Date : 12/13/2016

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Directions to “ PHYLLIS PAMELA CALDERON CAS” Practice Location

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