1619232683 NPI number — MISS DANIELE ASHLEY SMITH CABALLE

Table of content: MISS DANIELE ASHLEY SMITH CABALLE (NPI 1619232683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619232683 NPI number — MISS DANIELE ASHLEY SMITH CABALLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABALLE
Provider First Name:
DANIELE
Provider Middle Name:
ASHLEY SMITH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CABALLE
Provider Other First Name:
DANIEL
Provider Other Middle Name:
ROBERT SMITH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619232683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2437 LAKE VISTA CT
Provider Second Line Business Mailing Address:
APT 107
Provider Business Mailing Address City Name:
CASSELBERRY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32707-6470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-721-4100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 N LAKEMONT AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-830-6412
Provider Business Practice Location Address Fax Number:
407-830-8413
Provider Enumeration Date:
07/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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