Provider Demographics
NPI:1306072913
Name:PABLO, TRAVIS O'NEIL (CSA)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:O'NEIL
Last Name:PABLO
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 CARMIL CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-2931
Mailing Address - Country:US
Mailing Address - Phone:502-533-6924
Mailing Address - Fax:
Practice Address - Street 1:7601 CARMIL CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-2931
Practice Address - Country:US
Practice Address - Phone:502-533-6924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA161246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant