Healthcare Provider Details

I. General information

NPI: 1508480617
Provider Name (Legal Business Name): ROGELIO R CABRERA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15529 BULL RUN RD
MIAMI LAKES FL
33014-7004
US

IV. Provider business mailing address

15459 SW 143RD TER
MIAMI FL
33196-6032
US

V. Phone/Fax

Practice location:
  • Phone: 305-328-8922
  • Fax: 786-224-6489
Mailing address:
  • Phone: 786-383-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: