Provider Demographics
NPI:1225324338
Name:CABRERA, ELADIO (LMT)
Entity Type:Individual
Prefix:
First Name:ELADIO
Middle Name:
Last Name:CABRERA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 NW 72ND AVE STE 650
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1921
Mailing Address - Country:US
Mailing Address - Phone:305-592-6966
Mailing Address - Fax:305-592-6977
Practice Address - Street 1:1150 NW 72ND AVE STE 650
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1921
Practice Address - Country:US
Practice Address - Phone:305-592-6966
Practice Address - Fax:305-592-6977
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62276225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist