MEDICARE: YOEL CABALLERO X RAY TECHNICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247100000X	Radiologic Technologist	CRT63240	FL

General Provider Information

NPI Number	:	1740579002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOEL CABALLERO X RAY TECHNICIAN

Provider Business Mailing Address
First Line	:	2471 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3150
Country	:	US
Telephone Number	:	786-275-4514
Fax Number	:	786-275-4516

Provider Business Practice Location Address
First Line	:	2471 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3150
Country	:	US
Telephone Number	:	786-275-4514
Fax Number	:	786-275-4516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/06/2011

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