Healthcare Provider Details

I. General information

NPI: 1124949284
Provider Name (Legal Business Name): SAMUEL CABALLERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6819 W TROPICANA AVE STE 100
LAS VEGAS NV
89103-4929
US

IV. Provider business mailing address

6819 W TROPICANA AVE STE 100
LAS VEGAS NV
89103-4929
US

V. Phone/Fax

Practice location:
  • Phone: 702-364-5130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT13002
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: