Provider Demographics
NPI:1396085114
Name:CEBALLOS CALDERA, CESAR
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:CEBALLOS CALDERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 N ORANGE GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3333
Mailing Address - Country:US
Mailing Address - Phone:626-796-3453
Mailing Address - Fax:
Practice Address - Street 1:855 N ORANGE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3333
Practice Address - Country:US
Practice Address - Phone:626-796-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator