Provider Demographics
NPI:1447530233
Name:CALEYO, DOMINGO J (MA)
Entity type:Individual
Prefix:MR
First Name:DOMINGO
Middle Name:J
Last Name:CALEYO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 W 16TH AVE
Mailing Address - Street 2:STE 312
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7189
Mailing Address - Country:US
Mailing Address - Phone:305-640-5977
Mailing Address - Fax:305-381-0985
Practice Address - Street 1:4445 W 16TH AVE
Practice Address - Street 2:STE 312
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7189
Practice Address - Country:US
Practice Address - Phone:305-640-5977
Practice Address - Fax:305-381-0985
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52345273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit