Provider Demographics
NPI:1134499239
Name:CEBALLOS, CARIDAD
Entity type:Individual
Prefix:
First Name:CARIDAD
Middle Name:
Last Name:CEBALLOS
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 1:6530 MANOR LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4647
Mailing Address - Country:US
Mailing Address - Phone:305-898-3724
Mailing Address - Fax:
Practice Address - Street 1:7811 CORAL WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6540
Practice Address - Country:US
Practice Address - Phone:305-264-1294
Practice Address - Fax:305-264-1293
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist