=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295738607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR CABEZUDO ARNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19065 FLY ROD RUN
-----------------------------------------------------
City | LOXAHATCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-6024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-635-8855
-----------------------------------------------------
Fax | 561-635-8855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 540233
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33454-0233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-635-8855
-----------------------------------------------------
Fax | 561-635-8855
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ARNP3162712
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------