Provider Demographics
NPI:1568600013
Name:CABALLES, VIDA ALIP (RDA)
Entity Type:Individual
Prefix:MRS
First Name:VIDA
Middle Name:ALIP
Last Name:CABALLES
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E MAPLE ST APT A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2195
Mailing Address - Country:US
Mailing Address - Phone:818-549-0871
Mailing Address - Fax:
Practice Address - Street 1:313 E MAPLE ST APT A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2195
Practice Address - Country:US
Practice Address - Phone:818-549-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36932126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant