Provider Demographics
NPI:1114597929
Name:CABALES, KRISTINA ALEXANDRIA (LAC)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ALEXANDRIA
Last Name:CABALES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:889 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1702
Mailing Address - Country:US
Mailing Address - Phone:631-337-2022
Mailing Address - Fax:631-751-8298
Practice Address - Street 1:889 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1702
Practice Address - Country:US
Practice Address - Phone:631-337-2022
Practice Address - Fax:631-751-8298
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19032171100000X
NY007082171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist