Healthcare Provider Details

I. General information

NPI: 1902912454
Provider Name (Legal Business Name): LUIS RENE CABRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/05/2021
Certification Date: 12/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4731
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-2000
  • Fax: 305-957-1166
Mailing address:
  • Phone: 305-505-5530
  • Fax: 305-675-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME87357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: