Provider Demographics
NPI:1366694630
Name:CABALLERO, VERONICA BURCIAGA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:BURCIAGA
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4767 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3349
Mailing Address - Country:US
Mailing Address - Phone:510-409-3192
Mailing Address - Fax:
Practice Address - Street 1:3161 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2216
Practice Address - Country:US
Practice Address - Phone:510-796-1000
Practice Address - Fax:510-796-1060
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant