Provider Demographics
NPI:1689884025
Name:CABALLERO, JOSE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 MEEKS BAY DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1652
Mailing Address - Country:US
Mailing Address - Phone:619-941-1175
Mailing Address - Fax:619-941-1175
Practice Address - Street 1:2468 JOSE CLEMENTE OROZCO
Practice Address - Street 2:405
Practice Address - City:TIJUANA
Practice Address - State:BC
Practice Address - Zip Code:22320
Practice Address - Country:MX
Practice Address - Phone:619-734-2353
Practice Address - Fax:619-941-1175
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA678456 FOREIGN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice