Provider Demographics
NPI:1164958690
Name:CABALLERO, DIANE ELAINE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ELAINE
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:E
Other - Last Name:STUBBS-CASSIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1925 S MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-7228
Mailing Address - Country:US
Mailing Address - Phone:405-657-8530
Mailing Address - Fax:
Practice Address - Street 1:1925 S MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-7228
Practice Address - Country:US
Practice Address - Phone:405-657-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst