MEDICARE: JESSICA CABALLERO

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1306323811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CABALLERO

Provider Business Mailing Address
First Line	:	1612 1ST ST
Second Line	:
City	:	COACHELLA
State	:	CA
Zip	:	92236-1407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	83912 AVENUE 45
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-7351
Country	:	US
Telephone Number	:	760-347-0754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	04/22/2024

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