1134209562 NPI number — MICHELLE RAYE CABALLERO M.D.

Table of content: MICHELLE RAYE CABALLERO M.D. (NPI 1134209562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134209562 NPI number — MICHELLE RAYE CABALLERO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABALLERO
Provider First Name:
MICHELLE
Provider Middle Name:
RAYE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALTON
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
RAYE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134209562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6621 FANNIN STREET
Provider Second Line Business Mailing Address:
A3300
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-824-1000
Provider Business Mailing Address Fax Number:
832-822-0752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17580 IH 45 SOUTH
Provider Second Line Business Practice Location Address:
WL-330
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-267-5000
Provider Business Practice Location Address Fax Number:
832-822-0752
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP3000X , with the licence number:  M1554 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 176295701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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