Provider Demographics
NPI:1912380122
Name:LALCEBO, MAYULI
Entity Type:Individual
Prefix:
First Name:MAYULI
Middle Name:
Last Name:LALCEBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W 75TH ST
Mailing Address - Street 2:201
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4068
Mailing Address - Country:US
Mailing Address - Phone:305-924-2846
Mailing Address - Fax:
Practice Address - Street 1:845 W 75TH ST
Practice Address - Street 2:201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4068
Practice Address - Country:US
Practice Address - Phone:305-924-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 14450224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant