Provider Demographics
NPI:1740247683
Name:CABALLERO-LOPEZ, JOSE ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:CABALLERO-LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1874
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1874
Mailing Address - Country:US
Mailing Address - Phone:787-286-1431
Mailing Address - Fax:
Practice Address - Street 1:30 CALLE PADIAL
Practice Address - Street 2:GATSBY PLAZA SUITE 314
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3597
Practice Address - Country:US
Practice Address - Phone:787-286-1431
Practice Address - Fax:787-286-1431
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR130822084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry