Provider Demographics
NPI:1558694794
Name:CABELLO, MARYROSE D (LAC, LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARYROSE
Middle Name:D
Last Name:CABELLO
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:MARYROSE
Other - Middle Name:S
Other - Last Name:UGUIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103-22 PLATTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2638
Mailing Address - Country:US
Mailing Address - Phone:718-570-4943
Mailing Address - Fax:
Practice Address - Street 1:80 E 11TH ST
Practice Address - Street 2:SUITE 236
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6811
Practice Address - Country:US
Practice Address - Phone:718-570-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003951171100000X
NY015636-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist