Organization
EVOLVING PATHWAYS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSIE CALDERA PSY.D (CLINICAL PSYCHOLOGIST)
(424) 212-3212
Entity
Organization
Contact information
Practice address
16801 BOLLINGER DR, PACIFIC PALISADES, CA 90272-3220
(424) 212-3212
Mailing address
16801 BOLLINGER DR, PACIFIC PALISADES, CA 90272-3220
(424) 212-3212
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB297075
MEDICARE ID
CA
05
—
CB297075
—
CA
Enumeration date
07/16/2020
Last updated
07/17/2020
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