Provider Demographics
NPI:1205139722
Name:CENTRO MEDICINA PREVENTIVA DR. BARUCH CABALLERO VALIENTE
Entity type:Organization
Organization Name:CENTRO MEDICINA PREVENTIVA DR. BARUCH CABALLERO VALIENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BAEUCH
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-200-5414
Mailing Address - Street 1:PO BOX 79061
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9061
Mailing Address - Country:US
Mailing Address - Phone:787-200-5414
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO CHEVERE AVENIDA JOSE DE DIEGO
Practice Address - Street 2:OFICINA 204 PDA 22 NUM 328
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:787-200-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6689207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080441Medicare PIN