Provider Demographics
NPI:1083989024
Name:DEL SOL PSYCHOLOGYCAL CENTER
Entity Type:Organization
Organization Name:DEL SOL PSYCHOLOGYCAL CENTER
Other - Org Name:DEL SOL PSYCHOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, PSYD
Authorized Official - Phone:909-608-9222
Mailing Address - Street 1:397 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4217
Mailing Address - Country:US
Mailing Address - Phone:909-608-9222
Mailing Address - Fax:
Practice Address - Street 1:397 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4217
Practice Address - Country:US
Practice Address - Phone:909-608-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27904302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization