Provider Demographics
NPI:1194011452
Name:CABALLERO-GIPPSON, EDESTHER ALEJANDRA
Entity Type:Individual
Prefix:
First Name:EDESTHER
Middle Name:ALEJANDRA
Last Name:CABALLERO-GIPPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CABALLERO
Other - Middle Name:
Other - Last Name:GIPPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PH D
Mailing Address - Street 1:368 AVE DE DIEGO
Mailing Address - Street 2:CRYSTAL HOUSE APT 602
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00923-2916
Mailing Address - Country:US
Mailing Address - Phone:787-530-6633
Mailing Address - Fax:
Practice Address - Street 1:PMB 410 DE DIEGO AVE 89
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-530-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical