Provider Demographics
NPI:1285453621
Name:CALDEIRA, ALEXANDRA MARITZA
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARITZA
Last Name:CALDEIRA
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 1:245 KENTUCKY ST STE E
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2877
Mailing Address - Country:US
Mailing Address - Phone:415-212-9064
Mailing Address - Fax:
Practice Address - Street 1:245 KENTUCKY ST STE E
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2877
Practice Address - Country:US
Practice Address - Phone:415-212-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146116106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty