Provider Demographics
NPI:1053759084
Name:CABRAL, LATASHA MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:MARIE
Last Name:CABRAL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LATASHA
Other - Middle Name:MARIE
Other - Last Name:HEAPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3001 BROADMOOR BLVD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-2100
Mailing Address - Country:US
Mailing Address - Phone:505-994-7000
Mailing Address - Fax:
Practice Address - Street 1:580 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1718
Practice Address - Country:US
Practice Address - Phone:603-354-5454
Practice Address - Fax:603-354-6535
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61083367500000X
NH067601-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered