Healthcare Provider Details

I. General information

NPI: 1407584683
Provider Name (Legal Business Name): JUAN ANTONIO ALFONSO CABRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 03/06/2024
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 METROPOLIS WAY STE 101
ORLANDO FL
32811-2706
US

IV. Provider business mailing address

5920 METROPOLIS WAY STE 1
ORLANDO FL
32811-2705
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4827
  • Fax: 855-540-0677
Mailing address:
  • Phone: 844-665-4827
  • Fax: 855-540-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023425
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: