Healthcare Provider Details

I. General information

NPI: 1578098976
Provider Name (Legal Business Name): MARIELLA J CABRERA QUIJADA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 COURTLAND BLVD
DELTONA FL
32738-8902
US

IV. Provider business mailing address

1651 N SEMORAN BLVD
ORLANDO FL
32807-3575
US

V. Phone/Fax

Practice location:
  • Phone: 407-249-1234
  • Fax: 407-249-1755
Mailing address:
  • Phone: 407-249-1234
  • Fax: 407-249-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME143374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: