Healthcare Provider Details

I. General information

NPI: 1831612993
Provider Name (Legal Business Name): AGUSTIN JOSE CABRERA GONCALVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 NW 10TH AVE FL 1
MIAMI FL
33136-1013
US

IV. Provider business mailing address

11788 SW 151ST PATH
MIAMI FL
33196-2563
US

V. Phone/Fax

Practice location:
  • Phone: 713-289-9023
  • Fax: 305-243-6708
Mailing address:
  • Phone: 713-289-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME156145
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME156145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: