Provider Demographics
NPI:1295246759
Name:CABALLERO MARTINEZ, IMAYRA
Entity type:Individual
Prefix:MS
First Name:IMAYRA
Middle Name:
Last Name:CABALLERO MARTINEZ
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 1:568 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2152
Mailing Address - Country:US
Mailing Address - Phone:239-236-6097
Mailing Address - Fax:
Practice Address - Street 1:7941 W 30TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3831
Practice Address - Country:US
Practice Address - Phone:305-824-0230
Practice Address - Fax:305-907-5322
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty