Provider Demographics
NPI:1881346088
Name:CABALLERO, BRENDA MARIA (BC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIA
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 E LA VERNE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2844
Mailing Address - Country:US
Mailing Address - Phone:909-442-3273
Mailing Address - Fax:
Practice Address - Street 1:695 E LA VERNE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2844
Practice Address - Country:US
Practice Address - Phone:909-442-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty