MEDICARE: DR. JOSE A CABALLERO DDS

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	1223G0001X	General Practice Dentistry	678456 FOREIGN	CA

General Provider Information

NPI Number	:	1689884025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE A CABALLERO DDS

Provider Business Mailing Address
First Line	:	1908 MEEKS BAY DR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-1652
Country	:	US
Telephone Number	:	619-941-1175
Fax Number	:	619-941-1175

Provider Business Practice Location Address
First Line	:	2468 JOSE CLEMENTE OROZCO
Second Line	:	405
City	:	TIJUANA
State	:	BC
Zip	:	22320
Country	:	MX
Telephone Number	:	619-734-2353
Fax Number	:	619-941-1175

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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