Provider Demographics
NPI:1639602691
Name:FUENTES CALDERON, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:FUENTES 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 1:16255 VENTURA BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2317
Mailing Address - Country:US
Mailing Address - Phone:801-823-0189
Mailing Address - Fax:
Practice Address - Street 1:7253 PURDUE AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5919
Practice Address - Country:US
Practice Address - Phone:619-844-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-17-7616106E00000X
CA1-20-46457103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst