Provider Demographics
NPI:1578853347
Name:CALDERON, ELIA I (MA)
Entity type:Individual
Prefix:
First Name:ELIA
Middle Name:I
Last Name:CALDERON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16417 BUTTERNUT CT
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:CA
Mailing Address - Zip Code:95315-9574
Mailing Address - Country:US
Mailing Address - Phone:209-648-7780
Mailing Address - Fax:
Practice Address - Street 1:16417 BUTTERNUT CT
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:CA
Practice Address - Zip Code:95315-9574
Practice Address - Country:US
Practice Address - Phone:209-648-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAIMF100442390200000X
CALMFT103926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program