MEDICARE: KATIUSKA OLIVA CABRERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	0-19-10067	FL
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1184164212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIUSKA OLIVA CABRERA

Provider Business Mailing Address
First Line	:	1513 NE 18TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-1656
Country	:	US
Telephone Number	:	239-258-8074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 NE 18TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-1656
Country	:	US
Telephone Number	:	239-258-8074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	07/20/2019

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