Provider Demographics
NPI:1689748535
Name:CABALLERO, LUDIVINIA GONZALES (MD)
Entity Type:Individual
Prefix:DR
First Name:LUDIVINIA
Middle Name:GONZALES
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1522
Mailing Address - Country:US
Mailing Address - Phone:845-496-5323
Mailing Address - Fax:
Practice Address - Street 1:25 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1522
Practice Address - Country:US
Practice Address - Phone:845-496-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics