Provider Demographics
NPI:1942417365
Name:CABALLERO, MARIA VIRGINIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VIRGINIA
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 1:1829 E TYROL PL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5440
Mailing Address - Country:US
Mailing Address - Phone:714-292-9025
Mailing Address - Fax:
Practice Address - Street 1:500 N ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2647
Practice Address - Country:US
Practice Address - Phone:714-502-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant