Provider Demographics
NPI:1144425877
Name:CABLING, FERNANDO PALIS (OTRL)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:PALIS
Last Name:CABLING
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:MR
Other - First Name:GRADY
Other - Middle Name:PALIS
Other - Last Name:CABLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:721 BAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-4029
Mailing Address - Country:US
Mailing Address - Phone:619-421-8656
Mailing Address - Fax:
Practice Address - Street 1:4510 VIEWRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1637
Practice Address - Country:US
Practice Address - Phone:858-694-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1374225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
437855OtherNBCOT