Provider Demographics
NPI:1265211296
Name:CABAN, ORNIEL YAMIL
Entity type:Individual
Prefix:
First Name:ORNIEL
Middle Name:YAMIL
Last Name:CABAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 SEDGE GRASS WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4486
Mailing Address - Country:US
Mailing Address - Phone:787-508-3661
Mailing Address - Fax:
Practice Address - Street 1:1205 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4046
Practice Address - Country:US
Practice Address - Phone:407-847-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist