Healthcare Provider Details

I. General information

NPI: 1679551055
Provider Name (Legal Business Name): JORGE LUIS CABRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W 49TH ST
HIALEAH FL
33012-3711
US

IV. Provider business mailing address

175 W 49TH ST
HIALEAH FL
33012-3711
US

V. Phone/Fax

Practice location:
  • Phone: 786-621-9777
  • Fax: 786-621-9601
Mailing address:
  • Phone: 786-621-9777
  • Fax: 786-621-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0049402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: