Healthcare Provider Details

I. General information

NPI: 1407866486
Provider Name (Legal Business Name): ODETTE SOLLA-CABRERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BOLTON ST MARLBORO PEDIATRICS
MARLBORO MA
01752
US

IV. Provider business mailing address

320 BOLTON ST MARLBORO PEDIATRICS
MARLBORO MA
01752
US

V. Phone/Fax

Practice location:
  • Phone: 508-460-9670
  • Fax:
Mailing address:
  • Phone: 508-460-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59542
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: