Provider Demographics
NPI:1598416505
Name:CHUQUIPUL CALDERON, STEPHANIE GEORGINA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GEORGINA
Last Name:CHUQUIPUL CALDERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 W BLAINE ST APT 204
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7677
Mailing Address - Country:US
Mailing Address - Phone:951-892-9471
Mailing Address - Fax:
Practice Address - Street 1:1144 W BLAINE ST APT 204
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7677
Practice Address - Country:US
Practice Address - Phone:951-892-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist