Provider Demographics
NPI:1194585935
Name:CABRERA FERNANDEZ, ROSALMYS
Entity type:Individual
Prefix:
First Name:ROSALMYS
Middle Name:
Last Name:CABRERA FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2265
Mailing Address - Country:US
Mailing Address - Phone:954-478-2027
Mailing Address - Fax:
Practice Address - Street 1:2116 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2265
Practice Address - Country:US
Practice Address - Phone:954-478-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-333221106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician