Provider Demographics
NPI:1083417364
Name:CABALLERO GONZALEZ, CAMILA
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:
Last Name:CABALLERO GONZALEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SW 37TH AVE APT 33
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4278
Mailing Address - Country:US
Mailing Address - Phone:305-972-5191
Mailing Address - Fax:
Practice Address - Street 1:901 SW 37TH AVE APT 33
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4278
Practice Address - Country:US
Practice Address - Phone:305-972-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-399767106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician