Basic Information
| Provider Information | |||||||||
| NPI: | 1174106157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABALLERO OSORIO | ||||||||
| FirstName: | KELYS | ||||||||
| MiddleName: | LEONOR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 NW 9TH TER APT 411 | ||||||||
| Address2: | |||||||||
| City: | HALLANDALE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330093968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7869427522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8880 ROYAL PALM BLVD | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552266633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2021 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 15608I | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 261QP2300X | 1371 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 208D00000X | 1371 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.