Provider Demographics
NPI:1669070959
Name:CABRERA CANET, TAMARA CAMILA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:CAMILA
Last Name:CABRERA CANET
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 1:7012 NW 179TH ST APT 205
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5416
Mailing Address - Country:US
Mailing Address - Phone:502-337-4546
Mailing Address - Fax:
Practice Address - Street 1:7012 NW 179TH ST APT 205
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5416
Practice Address - Country:US
Practice Address - Phone:502-337-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-137973106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician