Healthcare Provider Details

I. General information

NPI: 1053321307
Provider Name (Legal Business Name): JUAN MANUEL CABRERA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 AVE ANDALUCIA PUERTO NUEVO
SAN JUAN PR
00920-4130
US

IV. Provider business mailing address

16 VALLE ESCONDIDO
GUAYNABO PR
00971-8000
US

V. Phone/Fax

Practice location:
  • Phone: 787-273-1410
  • Fax: 787-706-1292
Mailing address:
  • Phone: 787-642-0835
  • Fax: 787-706-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2415
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: