Healthcare Provider Details

I. General information

NPI: 1295069730
Provider Name (Legal Business Name): IVELISSE FEBRES CABRERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 4251
LUQUILLO PR
00773-9860
US

IV. Provider business mailing address

HC 2 BOX 4251
LUQUILLO PR
00773-9860
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-3496
  • Fax: 787-889-3496
Mailing address:
  • Phone: 787-889-3496
  • Fax: 787-889-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17753
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: