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NPI Code Detail

MEDICARE: KIMBERLY CABALLEROS

MEDICARE: KIMBERLY CABALLEROS
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1891103776
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY CABALLEROS
Provider Business Mailing Address
First Line : 7410 HIGHVIEW DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40228-1611
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2816 DEL RIO PL
Second Line : SUITE 5
City : LOUISVILLE
State : KY
Zip : 40220-2349
Country : US
Telephone Number : 502-471-1309
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2014
Last Update Date : 07/23/2014

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Directions to “ KIMBERLY CABALLEROS ” Practice Location

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