Healthcare Provider Details

I. General information

NPI: 1225954753
Provider Name (Legal Business Name): CABRERA PRIMARY MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16401 SW 95TH ST
MIAMI FL
33196-1061
US

IV. Provider business mailing address

16401 SW 95TH ST
MIAMI FL
33196-1061
US

V. Phone/Fax

Practice location:
  • Phone: 786-720-8778
  • Fax:
Mailing address:
  • Phone: 786-720-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISET CABRERA MENDOZA
Title or Position: OWNER
Credential: FNP-C
Phone: 786-720-8778