Provider Demographics
NPI:1700642790
Name:CABRALES REYES, MAIKEL YUNIOR (SA-C)
Entity Type:Individual
Prefix:
First Name:MAIKEL
Middle Name:YUNIOR
Last Name:CABRALES REYES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 LAKESIDE ESTATES DR APT 1710
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2482
Mailing Address - Country:US
Mailing Address - Phone:346-932-1256
Mailing Address - Fax:
Practice Address - Street 1:1445 LAKESIDE ESTATES DR APT 1710
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2482
Practice Address - Country:US
Practice Address - Phone:346-932-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-164246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant