Provider Demographics
NPI:1083895130
Name:OPILAS, MARIA VICTORIA CABRERA
Entity Type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:CABRERA
Last Name:OPILAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA VICTORIA
Other - Middle Name:MADDELA
Other - Last Name:CABRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 N JOHN REDDITT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-2620
Mailing Address - Country:US
Mailing Address - Phone:936-632-2107
Mailing Address - Fax:936-632-2108
Practice Address - Street 1:216 N JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2620
Practice Address - Country:US
Practice Address - Phone:936-632-2107
Practice Address - Fax:936-632-2108
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G3284Medicare UPIN