Healthcare Provider Details

I. General information

NPI: 1891377651
Provider Name (Legal Business Name): MARIANNA SOPHIA CABALLERO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 2 BOX 60
APO AE
09094-9001
US

IV. Provider business mailing address

OPC 2 BOX 60
APO AE
09094-9001
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2538
  • Fax:
Mailing address:
  • Phone: 314-479-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS20034
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0520034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: