MEDICARE: MELISSA ELIZABETH 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	106S00000X	Behavior Technician	RBT-21-162837	NV

General Provider Information

NPI Number	:	1346822202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ELIZABETH CABALLERO

Provider Business Mailing Address
First Line	:	5438 STRAWBERRY SWING ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5438 STRAWBERRY SWING ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4230
Country	:	US
Telephone Number	:	702-747-0074
Fax Number	:

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	05/18/2021

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