Healthcare Provider Details

I. General information

NPI: 1750214847
Provider Name (Legal Business Name): MARIA GUADALUPE CABALLERO JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 INDIANA AVE STE 110
RIVERSIDE CA
92506-4297
US

IV. Provider business mailing address

29551 KYLES CIR
WINCHESTER CA
92596-6050
US

V. Phone/Fax

Practice location:
  • Phone: 951-223-5967
  • Fax:
Mailing address:
  • Phone: 714-343-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22281
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: