Provider Demographics
NPI:1396242020
Name:APORTELA, MABEL V
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:V
Last Name:APORTELA
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 1:2346 SEBAGO DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-8005
Mailing Address - Country:US
Mailing Address - Phone:678-799-1226
Mailing Address - Fax:
Practice Address - Street 1:2346 SEBAGO DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-8005
Practice Address - Country:US
Practice Address - Phone:678-799-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician