Provider Demographics
NPI:1790390250
Name:MARTINEZ CABALLERO, ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:MARTINEZ CABALLERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 BISCAYNE BLVD # 1134
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:305-891-2045
Practice Address - Street 1:4225 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5835
Practice Address - Country:US
Practice Address - Phone:786-828-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2023-07-09
Deactivation Date:2021-03-24
Deactivation Code:
Reactivation Date:2022-02-11
Provider Licenses
StateLicense IDTaxonomies
PR22919208D00000X
FLACN1488208D00000X
FL36903390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice