Healthcare Provider Details

I. General information

NPI: 1912512310
Provider Name (Legal Business Name): CLEMENTINA AURORA CABRERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

2320 SOARING EAGLE PL
LAKE MARY FL
32746-4622
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8178
  • Fax:
Mailing address:
  • Phone: 407-969-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME169477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: