Provider Demographics
NPI:1902931363
Name:CABALEIRO, MERCEDES DE LOS ANGELES (MD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:DE LOS ANGELES
Last Name:CABALEIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8000 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4621
Mailing Address - Country:US
Mailing Address - Phone:305-759-4778
Mailing Address - Fax:305-675-5753
Practice Address - Street 1:1609 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3733
Practice Address - Country:US
Practice Address - Phone:407-944-1319
Practice Address - Fax:305-675-5753
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15961208D00000X
FLACN315208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGQ604ZMedicare PIN