Healthcare Provider Details

I. General information

NPI: 1811052707
Provider Name (Legal Business Name): FERNADO CABANILLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 PONCE DE LEON PARADA 37
SAN JUAN PR
00918
US

IV. Provider business mailing address

PO BOX 362712
SAN JUAN PR
00936-2712
US

V. Phone/Fax

Practice location:
  • Phone: 787-771-7933
  • Fax: 787-294-0535
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4069
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: