Provider Demographics
NPI:1770909558
Name:CABALLERO, PATRICIA ELLEN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLEN
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 E VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1013
Mailing Address - Country:US
Mailing Address - Phone:805-981-5583
Mailing Address - Fax:805-981-5674
Practice Address - Street 1:4333 E VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1013
Practice Address - Country:US
Practice Address - Phone:805-981-5583
Practice Address - Fax:805-981-5674
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT77125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist