Healthcare Provider Details

I. General information

NPI: 1982900957
Provider Name (Legal Business Name): MANUEL DAVID CABRERA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 N KENDALL DR
MIAMI FL
33186-1708
US

IV. Provider business mailing address

18100 NE 19TH AVE
N MIAMI BEACH FL
33162-1606
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3800
  • Fax:
Mailing address:
  • Phone: 904-886-5385
  • Fax: 904-647-7727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: