Provider Demographics
NPI:1184191264
Name:CABALLERO, KAYLEA L (PTA)
Entity Type:Individual
Prefix:
First Name:KAYLEA
Middle Name:L
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13031 BARRETT LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1381
Mailing Address - Country:US
Mailing Address - Phone:714-661-7953
Mailing Address - Fax:
Practice Address - Street 1:13031 BARRETT LN
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1381
Practice Address - Country:US
Practice Address - Phone:714-661-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49586225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant