Provider Demographics
NPI:1942858279
Name:CABRERA, ODAISY
Entity Type:Individual
Prefix:
First Name:ODAISY
Middle Name:
Last Name:CABRERA
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 1:12811 SW 43RD DR APT 114A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4117
Mailing Address - Country:US
Mailing Address - Phone:786-560-1335
Mailing Address - Fax:
Practice Address - Street 1:12811 SW 43RD DR APT 114A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4117
Practice Address - Country:US
Practice Address - Phone:786-560-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19-94400Medicaid