MEDICARE: REYNA YADIRA AGUILAR CALDERON

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	1041C0700X	Clinical Social Worker	111159	CA

General Provider Information

NPI Number	:	1700379138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNA YADIRA AGUILAR CALDERON

Provider Business Mailing Address
First Line	:	2958 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5826
Country	:	US
Telephone Number	:	323-526-4016
Fax Number	:

Provider Business Practice Location Address
First Line	:	2958 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5826
Country	:	US
Telephone Number	:	323-526-4016
Fax Number	:

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	11/15/2023

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