Provider Demographics
NPI:1093099913
Name:CABALLERO, LILA PAMELA
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:PAMELA
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14118 78TH AVE
Mailing Address - Street 2:APT 1E
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3377
Mailing Address - Country:US
Mailing Address - Phone:650-390-3212
Mailing Address - Fax:
Practice Address - Street 1:14118 78TH AVE
Practice Address - Street 2:APT 1E
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-3377
Practice Address - Country:US
Practice Address - Phone:650-390-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020916-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist