Provider Demographics
NPI:1831965706
Name:MEDINA-CALDERON, MARIELA
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:MEDINA-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 1:1720 N HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4521
Mailing Address - Country:US
Mailing Address - Phone:509-398-4472
Mailing Address - Fax:
Practice Address - Street 1:840 E PLUM ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1874
Practice Address - Country:US
Practice Address - Phone:509-765-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor