Basic Information
| Provider Information | |||||||||
| NPI: | 1467963819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALDERON | ||||||||
| FirstName: | VIOLETA | ||||||||
| MiddleName: | JASMIN | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 HUGHES WAY STE 150 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908101878 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1721 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232214134 | ||||||||
| FaxNumber: | 3232213231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2017 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 82254 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 82254 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.