Provider Demographics
NPI:1437671146
Name:CABRERA CEBALLOS, ANDRES ENRIQUE (SA-C)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:ENRIQUE
Last Name:CABRERA CEBALLOS
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 W 71ST TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7105
Mailing Address - Country:US
Mailing Address - Phone:786-709-5694
Mailing Address - Fax:
Practice Address - Street 1:3529 W 71ST TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7105
Practice Address - Country:US
Practice Address - Phone:786-709-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-358246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant