Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | ME83781 | FL |
NPI | 1003004540 |
---|---|
Provider Name | Dr. Jennine Marie Cabanellas |
First Address | Wellington, FL 33414-7210 |
Second Address | Wellington, FL 33414-7210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267983300 | (05) | FL |
H79838 | (02) |