Provider Demographics
NPI:1821045303
Name:MABIDA, MARK VINCENT CABALLERO (PT)
Entity type:Individual
Prefix:MR
First Name:MARK VINCENT
Middle Name:CABALLERO
Last Name:MABIDA
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:6635 APRIL BEND CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2086
Mailing Address - Country:US
Mailing Address - Phone:646-331-8588
Mailing Address - Fax:
Practice Address - Street 1:7229 W SAHARA AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2860
Practice Address - Country:US
Practice Address - Phone:702-586-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY27988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist