Provider Demographics
NPI:1073234209
Name:CARBALLIDO CABRERA, GRETHELL L
Entity Type:Individual
Prefix:
First Name:GRETHELL
Middle Name:L
Last Name:CARBALLIDO CABRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 22ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-5506
Mailing Address - Country:US
Mailing Address - Phone:239-321-2238
Mailing Address - Fax:
Practice Address - Street 1:5051 CASTELLO DR STE 35
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8984
Practice Address - Country:US
Practice Address - Phone:239-321-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician