Basic Information
| Provider Information | |||||||||
| NPI: | 1275895732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALIXTRO | ||||||||
| FirstName: | SIOMARA | ||||||||
| MiddleName: | MAGALY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA-MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6305 WOODMAN AVENUE | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188998499 | ||||||||
| FaxNumber: | 8445901562 | ||||||||
| Practice Location | |||||||||
| Address1: | 6305 WOODMAN AVE. | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189084999 | ||||||||
| FaxNumber: | 8445901562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 115058 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1275895732 | 05 | CA | MEDICAID |