Provider Demographics
NPI:1992076244
Name:CABRERA, JACLYN (LMT)
Entity type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:CABRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:140 NW 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5738
Mailing Address - Country:US
Mailing Address - Phone:786-273-5239
Mailing Address - Fax:
Practice Address - Street 1:140 NW 40TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5738
Practice Address - Country:US
Practice Address - Phone:786-273-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist