Provider Demographics
NPI:1396938965
Name:CABARGA, GONZALO JESUS (LDO)
Entity type:Individual
Prefix:MR
First Name:GONZALO
Middle Name:JESUS
Last Name:CABARGA
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11130 N KENDALL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-0939
Mailing Address - Country:US
Mailing Address - Phone:305-274-1313
Mailing Address - Fax:
Practice Address - Street 1:11130 N KENDALL DR STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0939
Practice Address - Country:US
Practice Address - Phone:305-274-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL935156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician