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General NPI Number Information
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NPI Number | 1326459306
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Entity Type | Individual
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Provider Name | MA CAUBALEJO PT
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Gender | Female
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 350 EAST LA CANADA BLVD
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City | AVONDALE
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State | AZ
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Zip | 85323
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Country | US
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Telephone | 623-932-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 12350 W CAMPBELL AVE
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City | AVONDALE
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State | AZ
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Zip | 85392-4295
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10787
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License Number State | AZ
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