Healthcare Provider Details

I. General information

NPI: 1245256684
Provider Name (Legal Business Name): JUAN JOSE CABANERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 N TOWNVILLE ST
SENECA SC
29678-2645
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-886-9300
  • Fax:
Mailing address:
  • Phone: 864-522-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number26426
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: