Provider Demographics
NPI:1013723675
Name:CALTENCO, CITLALMINA
Entity type:Individual
Prefix:
First Name:CITLALMINA
Middle Name:
Last Name:CALTENCO
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 1:1510 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-3636
Mailing Address - Country:US
Mailing Address - Phone:509-895-1112
Mailing Address - Fax:
Practice Address - Street 1:331 N 1ST ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2303
Practice Address - Country:US
Practice Address - Phone:509-573-5000
Practice Address - Fax:509-573-5050
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60990810163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse