Provider Demographics
NPI:1124535653
Name:HERNANDEZ CABALLERO, MARIDALYS
Entity type:Individual
Prefix:
First Name:MARIDALYS
Middle Name:
Last Name:HERNANDEZ CABALLERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CANAL ST APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4456
Mailing Address - Country:US
Mailing Address - Phone:786-370-6503
Mailing Address - Fax:
Practice Address - Street 1:230 CANAL ST APT 203
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4456
Practice Address - Country:US
Practice Address - Phone:786-370-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-345824106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty