Healthcare Provider Details

I. General information

NPI: 1942123708
Provider Name (Legal Business Name): GABRIEL CAVALCANTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 COLLEGE PKWY UNIT 36
MOBILE AL
36613-2842
US

IV. Provider business mailing address

5735 COLLEGE PKWY UNIT 36
MOBILE AL
36613-2842
US

V. Phone/Fax

Practice location:
  • Phone: 251-252-8929
  • Fax:
Mailing address:
  • Phone: 251-252-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: