1780287540 NPI number — BRIDGETTE GUADALUPE CALDERON ACSW

Table of content: BRIDGETTE GUADALUPE CALDERON ACSW (NPI 1780287540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780287540 NPI number — BRIDGETTE GUADALUPE CALDERON ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDERON
Provider First Name:
BRIDGETTE
Provider Middle Name:
GUADALUPE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JARAMILLO
Provider Other First Name:
BRIDGETTE
Provider Other Middle Name:
GUADALUPE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780287540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9441
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92427-0441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 E MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92408-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-717-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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