Provider Demographics
NPI:1578227872
Name:CABANILLAS, GRACE CATALINA
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:CATALINA
Last Name:CABANILLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:CATALINA
Other - Last Name:CABANILLAS ZAVALETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:34 GREEN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 GREEN ST FL 2
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3353
Practice Address - Country:US
Practice Address - Phone:908-930-0052
Practice Address - Fax:908-565-1529
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024199363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner