Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 123472 | AK |
NPI | 1003173824 |
---|---|
Provider Name | Andrea Caballero |
First Address | Soldotna, AK 99669-7559 |
Second Address | Anchorage, AK 99508-5392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 19/09/2019 |