Basic Information
| Provider Information | |||||||||
| NPI: | 1568949840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VEGA CALOCA | ||||||||
| FirstName: | ERICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3406 GROSSMONT DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085617119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 438 NORTH WHITE ROAD | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082546848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2018 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 106043 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.