Provider Demographics
NPI:1184414120
Name:CABRALES, MARIO LUIS (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:LUIS
Last Name:CABRALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 HAYES RD APT 814
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-6637
Mailing Address - Country:US
Mailing Address - Phone:786-793-5614
Mailing Address - Fax:
Practice Address - Street 1:6536 GREATWOOD PKWY STE A
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-7153
Practice Address - Country:US
Practice Address - Phone:713-725-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25-219246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant