Provider Demographics
NPI:1538816939
Name:CALIXTERIO, MARTIN (PMHNP)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:CALIXTERIO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:R
Other - Last Name:CALIXTERIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1710 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5304
Mailing Address - Country:US
Mailing Address - Phone:619-623-4556
Mailing Address - Fax:
Practice Address - Street 1:10459 MOUNTAIN VIEW AVE STE E
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2033
Practice Address - Country:US
Practice Address - Phone:909-792-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029014363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health