Provider Demographics
NPI:1922734433
Name:CABALLERO LUIS, YANELY
Entity Type:Individual
Prefix:
First Name:YANELY
Middle Name:
Last Name:CABALLERO LUIS
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 1:3618 LANTANA RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2247
Mailing Address - Country:US
Mailing Address - Phone:561-964-2526
Mailing Address - Fax:
Practice Address - Street 1:3618 LANTANA RD STE 202
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-2247
Practice Address - Country:US
Practice Address - Phone:561-964-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty