Provider Demographics
NPI:1750817763
Name:CABATIC, FLERIDA (RN)
Entity Type:Individual
Prefix:
First Name:FLERIDA
Middle Name:
Last Name:CABATIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27413 N 23RD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-4708
Mailing Address - Country:US
Mailing Address - Phone:623-582-0113
Mailing Address - Fax:623-516-0847
Practice Address - Street 1:27413 N 23RD DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-4708
Practice Address - Country:US
Practice Address - Phone:623-582-0113
Practice Address - Fax:623-516-0847
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL5762H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ092108Medicaid