Provider Demographics
NPI:1932524972
Name:CALIBOSO, MENCHIE (MT-BC)
Entity type:Individual
Prefix:
First Name:MENCHIE
Middle Name:
Last Name:CALIBOSO
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 SAN FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1452
Mailing Address - Country:US
Mailing Address - Phone:562-481-6588
Mailing Address - Fax:
Practice Address - Street 1:2810 SAN FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1452
Practice Address - Country:US
Practice Address - Phone:562-481-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10939225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist