Basic Information
| Provider Information | |||||||||
| NPI: | 1396782504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABALLERO | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100322 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782011622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758490 | ||||||||
| FaxNumber: | 2105758127 | ||||||||
| Practice Location | |||||||||
| Address1: | 8026 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758490 | ||||||||
| FaxNumber: | 2105758127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | K4382 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 118931807 | 01 | TX | MEDICAID TPI | OTHER | 0025GK | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 193334301 | 05 | TX | MEDICAID |