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NPI Code Detail

MEDICARE: SAMIRA JEZELL CABALLERO FNP

MEDICARE: SAMIRA JEZELL CABALLERO FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1144167081
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMIRA JEZELL CABALLERO FNP
Provider Business Mailing Address
First Line : 3550 LA JOLLA VILLAGE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92161-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3350 LA JOLLA VILLAGE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92161-0002
Country : US
Telephone Number : 858-552-8585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2026
Last Update Date : 04/29/2026

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Directions to “ SAMIRA JEZELL CABALLERO FNP” Practice Location

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