Provider Demographics
NPI:1750381497
Name:CABELLO-CANALES, MARIA M (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:CABELLO-CANALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7113 SAN PEDRO AVE
Mailing Address - Street 2:# 316
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6219
Mailing Address - Country:US
Mailing Address - Phone:210-745-0084
Mailing Address - Fax:210-745-0139
Practice Address - Street 1:7113 SAN PEDRO AVE # 316
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6219
Practice Address - Country:US
Practice Address - Phone:210-745-0084
Practice Address - Fax:210-745-0139
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8028208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102878903Medicaid
TX1028789-04Medicaid
TX8J1568Medicare PIN