Healthcare Provider Details

I. General information

NPI: 1962922740
Provider Name (Legal Business Name): JOHN TITO CABALLERO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 LEXINGTON AVE
EL MONTE CA
91731-2608
US

IV. Provider business mailing address

3614 HEMLOCK LN
WEST COVINA CA
91792-2710
US

V. Phone/Fax

Practice location:
  • Phone: 626-453-3700
  • Fax:
Mailing address:
  • Phone: 626-419-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number84609
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: