Basic Information
| Provider Information | |||||||||
| NPI: | 1497740955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CABEZAS | ||||||||
| FirstName: | WASHINGTON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 S CONGRESS AVE | ||||||||
| Address2: | BLDG. #300 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615484900 | ||||||||
| FaxNumber: | 5615484902 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 S CONGRESS AVE | ||||||||
| Address2: | BLDG. #300 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615484900 | ||||||||
| FaxNumber: | 5615484902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA2293 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 290671600 | 05 | FL | MEDICAID |