Provider Demographics
NPI:1003686924
Name:CABULOG
Entity Type:Organization
Organization Name:CABULOG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-829-6712
Mailing Address - Street 1:3440 HOLLYWOOD BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6933
Mailing Address - Country:US
Mailing Address - Phone:615-829-6712
Mailing Address - Fax:
Practice Address - Street 1:3440 HOLLYWOOD BLVD STE 415
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6933
Practice Address - Country:US
Practice Address - Phone:615-829-6712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies