=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366512899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HECTOR A CABALLERO MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32144 AGOLLRA ROAD SUITE 11B
-----------------------------------------------------
City | WESTLAKE VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-4087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-495-0823
-----------------------------------------------------
Fax | 818-889-7602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32144 AGOLLRA ROAD SUITE 11B
-----------------------------------------------------
City | WESTLAKE VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-4087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-495-0823
-----------------------------------------------------
Fax | 818-889-7602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HECTOR ALBERTO CABALLERO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-495-0823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------