Provider Demographics
NPI:1093935033
Name:CABANILLA MAZA, L INDA MARINA C (OTR)
Entity Type:Individual
Prefix:MS
First Name:L INDA MARINA
Middle Name:C
Last Name:CABANILLA MAZA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 SUTTER ST
Mailing Address - Street 2:STE. 208
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5417
Mailing Address - Country:US
Mailing Address - Phone:808-783-6701
Mailing Address - Fax:
Practice Address - Street 1:1499 SUTTER ST
Practice Address - Street 2:STE. 208
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5417
Practice Address - Country:US
Practice Address - Phone:808-783-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation