Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DL11793 | MA |
N | 1223P0300X | Periodontist | DN19684 | FL |
NPI | 1003153305 |
---|---|
Provider Name | Dr. Vianca Elize Cabrera |
First Address | Boston, MA 02118-4802 |
Second Address | Boston, MA 02118-2308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2013 |
Last Update Date | 08/01/2013 |