Healthcare Provider Details

I. General information

NPI: 1477145142
Provider Name (Legal Business Name): KEVIN JOSE CABALLERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 MEDICAL CENTER DR STE 100
TEXAS CITY TX
77591-2667
US

IV. Provider business mailing address

16840 BUCCANEER LN STE 261
HOUSTON TX
77058-2570
US

V. Phone/Fax

Practice location:
  • Phone: 281-991-2200
  • Fax: 281-991-7700
Mailing address:
  • Phone: 281-991-2200
  • Fax: 281-991-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberW8564
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberDR.0073329
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number36284R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: