Healthcare Provider Details

I. General information

NPI: 1326557893
Provider Name (Legal Business Name): CARMELITA CABALLES MEMBREVE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 SAN DIMAS ST STE B
BAKERSFIELD CA
93301-5725
US

IV. Provider business mailing address

2212 FIORI ST
DELANO CA
93215-9285
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-9999
  • Fax:
Mailing address:
  • Phone: 661-454-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: