Healthcare Provider Details

I. General information

NPI: 1023291762
Provider Name (Legal Business Name): SUELY ANN CABRAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 BERWICK DR
AURORA IL
60506-4403
US

IV. Provider business mailing address

353 BERWICK DR
AURORA IL
60506-4403
US

V. Phone/Fax

Practice location:
  • Phone: 630-906-7318
  • Fax: 630-566-0926
Mailing address:
  • Phone: 630-906-7318
  • Fax: 630-566-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: