Provider Demographics
NPI:1285034926
Name:CABRA, NYDIA LISETTE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:NYDIA
Middle Name:LISETTE
Last Name:CABRA
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:NYDIA
Other - Middle Name:LISETTE
Other - Last Name:OCAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:5201 NEW ORLEANS DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4792
Mailing Address - Country:US
Mailing Address - Phone:210-452-6689
Mailing Address - Fax:
Practice Address - Street 1:4901 E UNIVERSITY BLVD
Practice Address - Street 2:ATHLETIC TRAINING- GYM ROOM 111
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8122
Practice Address - Country:US
Practice Address - Phone:432-552-2679
Practice Address - Fax:432-552-3681
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT 1508390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program