Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 2470 | CA |
N | 225X00000X | Occupational Therapist | 2470 | CA |
Y | 225XH1200X | Occupational Therapist - Hand | 2470 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2470 | CA |
NPI | 1659383925 |
---|---|
Provider Name | Ms. Marianne Renee Caballero-Rodriguez |
First Address | Valley Springs, CA 95252-8971 |
Second Address | Stockton, CA 95207-8114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 24/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1172170 | FIRST HEALTH (01) | CA |
171713600 | DEPARTMENT OF LABOR (01) | CA |
5268870001 | DMERC (01) | CA |
5530198 | AETNA (01) | CA |
OT0024700 | BLUE SHIELD PIN (01) | CA |
P00066568 | MEDICARE RAILROAD (01) | AR |
ZZZ07989Z | BLUE SHIELD GROUP (01) | CA |