Basic Information
| Provider Information | |||||||||
| NPI: | 1538406442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JENNINE CABANELLAS, MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13421 SOUTHSHORE BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334147206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613333440 | ||||||||
| FaxNumber: | 5613333554 | ||||||||
| Practice Location | |||||||||
| Address1: | 13421 SOUTHSHORE BLVD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334147206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613333440 | ||||||||
| FaxNumber: | 5613333554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2013 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | CABANELLAS | ||||||||
| AuthorizedOfficialFirstName: | JENNINE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5613333440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME83781 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.