Provider Demographics
NPI:1902385776
Name:CABALLERO, JOSE CARLOS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 FONTAINEBLEAU BLVD APT 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6820
Mailing Address - Country:US
Mailing Address - Phone:786-413-7347
Mailing Address - Fax:
Practice Address - Street 1:1550 S DIXIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3034
Practice Address - Country:US
Practice Address - Phone:786-536-9714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker