Provider Demographics
NPI:1326557893
Name:MEMBREVE, CARMELITA CABALLES (NP-C)
Entity type:Individual
Prefix:
First Name:CARMELITA
Middle Name:CABALLES
Last Name:MEMBREVE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 FIORI ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-9285
Mailing Address - Country:US
Mailing Address - Phone:661-454-9026
Mailing Address - Fax:
Practice Address - Street 1:3805 SAN DIMAS ST STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5725
Practice Address - Country:US
Practice Address - Phone:661-326-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007436363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner