Provider Demographics
NPI:1760090609
Name:EVOLVING PATHWAYS INC.
Entity Type:Organization
Organization Name:EVOLVING PATHWAYS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-212-3212
Mailing Address - Street 1:16801 BOLLINGER DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3220
Mailing Address - Country:US
Mailing Address - Phone:424-212-3212
Mailing Address - Fax:
Practice Address - Street 1:16801 BOLLINGER DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3220
Practice Address - Country:US
Practice Address - Phone:424-212-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB297075Medicaid
CACB297075OtherMEDICARE ID