Healthcare Provider Details

I. General information

NPI: 1114617081
Provider Name (Legal Business Name): CAROLINA CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4661 SW 149TH CT
MIAMI FL
33185-4345
US

IV. Provider business mailing address

4661 SW 149TH CT
MIAMI FL
33185-4345
US

V. Phone/Fax

Practice location:
  • Phone: 786-370-0247
  • Fax:
Mailing address:
  • Phone: 786-370-0247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: