Baldomero Moreno Caballero
Individual provider Active NPI Athletic Trainer · Canton, MO
NPI 1457065583 · NPPES record last updated Jan 12, 2023
Key facts
- NPI
- 1457065583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 1 College HL
Canton, MO 63435-1299 - Phone
- (309) 489-5228
- NPI assigned
- Jan 12, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
1 College HL
Canton, MO 63435-1299
Mailing address
Carretera de Villaviciosa N3
Cordoba, CORDOBA 14012
ES
Other providers in Canton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.