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General NPI Number Information
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NPI Number | 1760922512
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Entity Type | Individual
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Provider Name | MANUEL ENRIQUE CABALLERO TABLADA ARNP
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Gender | Male
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/04/2023
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Provider Practice Location Address
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Address Line | 45 NW 8TH ST STE 106
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City | HOMESTEAD
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State | FL
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Zip | 33030-4452
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Country | US
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Telephone | 305-791-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 1986 SE 13TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33035-1933
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Country | US
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Telephone | 954-478-5178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP 9388601
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License Number State | FL
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