Provider Demographics
NPI:1013474394
Name:CABALLERO, ENRIQUE P (DME)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:P
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:DME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 GLENOAKS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-1072
Mailing Address - Country:US
Mailing Address - Phone:818-394-9071
Mailing Address - Fax:818-302-2317
Practice Address - Street 1:9980 GLENOAKS BLVD STE A
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1072
Practice Address - Country:US
Practice Address - Phone:818-394-9071
Practice Address - Fax:818-302-2317
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
D7393210OtherDURABLE MEDICAL EQUIPMENT