Provider Demographics
NPI:1538990726
Name:CALDERA AVILA, ESTEFANIA
Entity type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:
Last Name:CALDERA AVILA
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 1:6230 YAKIMA CT
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-6615
Mailing Address - Country:US
Mailing Address - Phone:775-357-6155
Mailing Address - Fax:
Practice Address - Street 1:955 S VIRGINIA ST STE 212
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2478
Practice Address - Country:US
Practice Address - Phone:775-357-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11188-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker