Provider Demographics
NPI:1548940604
Name:CABALLERO, JOHN EDDIE (SA-C, CST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDDIE
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:SA-C, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 AUGUSTA
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2313
Mailing Address - Country:US
Mailing Address - Phone:954-802-5134
Mailing Address - Fax:
Practice Address - Street 1:2091 AUGUSTA
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2313
Practice Address - Country:US
Practice Address - Phone:954-802-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-447246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant