MEDICARE: BIBIANA LIZBETH CALDERON CARDENAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	106H00000X	Marriage & Family Therapist	152316	CA

General Provider Information

NPI Number	:	1750528923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIBIANA LIZBETH CALDERON CARDENAS

Provider Business Mailing Address
First Line	:	4690 GENESEE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3000
Country	:	US
Telephone Number	:	858-277-4633
Fax Number	:	858-277-4933

Provider Business Practice Location Address
First Line	:	4690 GENESEE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3000
Country	:	US
Telephone Number	:	858-277-4633
Fax Number	:	858-277-4933

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

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	02/20/2025

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