Individual provider Active NPI

Yvonne Kathleen Calderon, DPT

  • Physical Therapist
  • Thousand Oaks, CA
National Provider Identifier
1679099790
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
294730 Issued in CA
Practice address
2230 Lynn Rd Ste 250
Thousand Oaks, CA 91360-1975
Phone
(805) 379-2132
Fax
(805) 917-4206
NPI assigned
Aug 21, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 294730 CA Primary

Addresses

Primary practice location

2230 Lynn Rd Ste 250
Thousand Oaks, CA 91360-1975

Mailing address

5720 Ralston St Ste 200
Ventura, CA 93003-7844
Phone (805) 804-4168

Other identifiers 1

IdentifierTypeStateIssuer
294730OtherCASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200701000317 CA Practitioner - Physical Therapist in Private Practice 3375803133 Reassigns benefits to 2 organizations
I20221110003160 AZ Practitioner - Physical Therapist in Private Practice 3375803133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Function for Life Physical Therapy IncGroup PAC ID 3678758489, 36 clinicians

Practice addresses (Care Compare)

555 N Bash St
El Segundo, CA 90245-2818
Phone (310) 666-9003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
294730CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Function for Life Physical Therapy, Inc. Physical Therapist CurrentSince Apr 29, 2024 Accepting new patients
Arizona Luna Care Physical Therapy, LLC Physical Therapist CurrentSince Aug 4, 2023 Accepting new patients

Locations

14050 N 83rd Ave
Ste 290
Peoria, AZ 85381
Phone (623) 261-1362

9097 E Desert Cove Ave
Ste 110
Scottsdale, AZ 85260
Phone (480) 860-4298

555 N Nash St
El Segundo, CA 90245
Phone (310) 386-6788

1084 N El Camino Real
#B351
Encinitas, CA 92024

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1679099790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5720 RALSTON ST STE 200",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930037844",
            "telephone_number": "805-804-4168",
            "fax_number": "805-830-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 LYNN RD STE 250",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913601975",
            "telephone_number": "805-379-2132",
            "fax_number": "805-917-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALDERON",
        "first_name": "YVONNE",
        "middle_name": "KATHLEEN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-21",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "294730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "294730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.