Healthcare Provider Details

I. General information

NPI: 1346734126
Provider Name (Legal Business Name): MARTHA CAABAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W MAIN ST STE 106
EL CENTRO CA
92243-2900
US

IV. Provider business mailing address

PO BOX 2219
EL CENTRO CA
92244-2219
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-6922
  • Fax: 760-353-8441
Mailing address:
  • Phone: 760-353-6922
  • Fax: 760-353-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: