Provider Demographics
NPI:1578621348
Name:CABALLERO, ADAN
Entity Type:Individual
Prefix:MR
First Name:ADAN
Middle Name:
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8037
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-8037
Mailing Address - Country:US
Mailing Address - Phone:956-973-0373
Mailing Address - Fax:956-447-0031
Practice Address - Street 1:108 W HUISACHE ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4727
Practice Address - Country:US
Practice Address - Phone:956-973-0373
Practice Address - Fax:956-447-0031
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56323747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000112900Medicaid
TX001002398Medicaid