Healthcare Provider Details

I. General information

NPI: 1164749586
Provider Name (Legal Business Name): JORGE ALEJANDRO CABALLERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1143
EL GRANADA CA
94018-1143
US

IV. Provider business mailing address

PO BOX 1143
EL GRANADA CA
94018-1143
US

V. Phone/Fax

Practice location:
  • Phone: 650-283-5024
  • Fax: 650-765-1560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA117878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: