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NPI Code Detail

MEDICARE: GISSELLE CABALLERO

MEDICARE:   GISSELLE  CABALLERO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1285202804
Entity Type Code : Individual
Provider Name (Legal Business Name) : GISSELLE CABALLERO
Provider Business Mailing Address
First Line : 10921 W WILLOW PEAK AVE
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85193-9304
Country : US
Telephone Number : 520-483-0391
Fax Number :
Provider Business Practice Location Address
First Line : 10921 W WILLOW PEAK AVE
Second Line :
City : CASA GRANDE
State : AZ
Zip : 85193-9304
Country : US
Telephone Number : 520-483-0391
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2021
Last Update Date : 06/11/2021

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Directions to “ GISSELLE CABALLERO ” Practice Location

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