Stacey Calderon
Individual provider Active NPI Behavior Analyst · Douglas, AZ
NPI 1124681572 · NPPES record last updated Sep 10, 2025
Key facts
- NPI
- 1124681572
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 1-23-65872 (AZ)
- Practice address
- 530 E 11TH St Unit 5
Douglas, AZ 85607-2014 - Phone
- (714) 393-9136
- NPI assigned
- Apr 20, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-23-65872 | AZ | Yes |
Addresses
Primary practice location
530 E 11TH St Unit 5
Douglas, AZ 85607-2014
Mailing address
125 Baker St Unit 311
Costa Mesa, CA 92626-4572
Phone (714) 393-9136
Other providers in Douglas, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.