Provider Demographics
NPI:1942073515
Name:MAS CABALLERO, GISELLE MARGARITA (PA-C)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:MARGARITA
Last Name:MAS 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 1:68 CENTER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3050
Mailing Address - Country:US
Mailing Address - Phone:856-580-1877
Mailing Address - Fax:
Practice Address - Street 1:1100 LIBERTY PL
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5708
Practice Address - Country:US
Practice Address - Phone:856-589-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00814800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant