Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 010273 | CT |
Y | 213EG0000X | General Practice | 010273 | CT |
NPI | 1003046764 |
---|---|
Provider Name | Leigh Mae Cabral |
First Address | Hartford, CT 06106-5501 |
Second Address | Hartford, CT 06106-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 02/11/2010 |