Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033368360 |
---|---|
Provider Name | Mr. Marcelo Cabral |
First Address | Los Angeles, CA 90029-3834 |
Second Address | Los Angeles, CA 90057-4310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 10/09/2008 |