Healthcare Provider Details

I. General information

NPI: 1972183028
Provider Name (Legal Business Name): ROBERTO CAO III MS, LAT, ATC, NREMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 SAN AMARO DR
CORAL GABLES FL
33146-2402
US

IV. Provider business mailing address

8217 SW 72ND AVE APT 1309
MIAMI FL
33143-7993
US

V. Phone/Fax

Practice location:
  • Phone: 305-331-2215
  • Fax:
Mailing address:
  • Phone: 305-331-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004341
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2178
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL7453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: