Provider Demographics
NPI:1720258056
Name:CENTENNIAL NEUROLOGY AND HEADACHE CENTER, PLLC
Entity Type:Organization
Organization Name:CENTENNIAL NEUROLOGY AND HEADACHE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-620-9187
Mailing Address - Street 1:1022 1ST ST N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8725
Mailing Address - Country:US
Mailing Address - Phone:205-620-9187
Mailing Address - Fax:205-620-9189
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:SUITE 300
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8725
Practice Address - Country:US
Practice Address - Phone:205-620-9187
Practice Address - Fax:205-620-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25521174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH97882Medicare UPIN