Healthcare Provider Details

I. General information

NPI: 1528322302
Provider Name (Legal Business Name): ANTONIO MANUEL CABRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W UNDERWOOD ST SUITE 200
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

1720 COOK AVE
ORLANDO FL
32806-2912
US

V. Phone/Fax

Practice location:
  • Phone: 407-237-6329
  • Fax: 407-649-3083
Mailing address:
  • Phone: 321-841-5236
  • Fax: 407-426-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number122671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: