Provider Demographics
NPI:1275981789
Name:CABALLERO MOYA, MARIA DEL CARMEN
Entity Type:Individual
Prefix:
First Name:MARIA DEL CARMEN
Middle Name:
Last Name:CABALLERO MOYA
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 1:717 PONCE DE LEON BLVD STE 212A
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2048
Mailing Address - Country:US
Mailing Address - Phone:786-558-4080
Mailing Address - Fax:
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 212A
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2048
Practice Address - Country:US
Practice Address - Phone:786-558-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLRN9475019163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst