Provider Demographics
NPI:1487315834
Name:CABALLERO, VICTOR MANUEL (SA-C)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 CALLA LILY CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-1909
Mailing Address - Country:US
Mailing Address - Phone:469-823-1719
Mailing Address - Fax:
Practice Address - Street 1:5410 CALLA LILY CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-1909
Practice Address - Country:US
Practice Address - Phone:469-823-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-746246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant