Provider Demographics
NPI:1831640143
Name:CABALLERO ORTIZ, MARIACARLA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MARIACARLA
Middle Name:
Last Name:CABALLERO ORTIZ
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NW 79TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4600
Mailing Address - Country:US
Mailing Address - Phone:305-913-8706
Mailing Address - Fax:
Practice Address - Street 1:3200 NW 79TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4600
Practice Address - Country:US
Practice Address - Phone:305-913-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist