Provider Demographics
NPI:1275309320
Name:CABERO, MIRANDA CORRINE (LMT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CORRINE
Last Name:CABERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:CORRINE
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:98-1445 KAMAHAO ST APT 69
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2429
Mailing Address - Country:US
Mailing Address - Phone:760-443-2863
Mailing Address - Fax:
Practice Address - Street 1:99-209 MOANALUA RD STE 314
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4042
Practice Address - Country:US
Practice Address - Phone:760-443-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-17410-0225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist