Basic Information
| Provider Information | |||||||||
| NPI: | 1336526052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABOS PERALTA | ||||||||
| FirstName: | RAUL | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11750 BIRD ROAD | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054806663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4525 W 6TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660497700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855055160 | ||||||||
| FaxNumber: | 7855055282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2015 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RR0500X | 0442769 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.