Provider Demographics
NPI:1114656352
Name:CABALLERO-MONRREAL, MARTHA LETICIA
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LETICIA
Last Name:CABALLERO-MONRREAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S MONTEZUMA CASTLE HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-7393
Mailing Address - Country:US
Mailing Address - Phone:928-202-0538
Mailing Address - Fax:
Practice Address - Street 1:155 S MONTEZUMA CASTLE HWY STE 3
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7393
Practice Address - Country:US
Practice Address - Phone:928-202-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27756225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty