Provider Demographics
NPI:1134926124
Name:CABALLERO VANEGAS, DIVANI GETZAMANI
Entity type:Individual
Prefix:MS
First Name:DIVANI
Middle Name:GETZAMANI
Last Name:CABALLERO VANEGAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W WILSON ST SPC 67
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1600
Mailing Address - Country:US
Mailing Address - Phone:714-981-7512
Mailing Address - Fax:
Practice Address - Street 1:500 S MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4514
Practice Address - Country:US
Practice Address - Phone:909-634-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician