Provider Demographics
NPI:1114429438
Name:CABRERA JAULAR, MAITE (SLP)
Entity Type:Individual
Prefix:
First Name:MAITE
Middle Name:
Last Name:CABRERA JAULAR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 W 16TH AVE STE 201-202
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2189
Mailing Address - Country:US
Mailing Address - Phone:305-456-2646
Mailing Address - Fax:305-967-8442
Practice Address - Street 1:5580 W 16TH AVE STE 201-202
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2189
Practice Address - Country:US
Practice Address - Phone:305-456-2646
Practice Address - Fax:305-967-8442
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty