Healthcare Provider Details

I. General information

NPI: 1891883484
Provider Name (Legal Business Name): PEDIATRIC PROVIDERS OF S. FLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 W 51ST PL
HIALEAH FL
33012-3620
US

IV. Provider business mailing address

464 W 51ST PL
HIALEAH FL
33012-3620
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-1281
  • Fax: 305-362-9138
Mailing address:
  • Phone: 305-557-1281
  • Fax: 305-362-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE LUIS CABRERA
Title or Position: OWNER
Credential: M.D.
Phone: 305-557-1281