=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528009271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISRAEL ENRIQUE CABRERA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 04/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2695 S LE JEUNE RD STE 200
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-5840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-529-5558
-----------------------------------------------------
Fax | 305-529-5854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1660 SW 150TH RD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33185-5768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-510-0471
-----------------------------------------------------
Fax | 305-220-0457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0064292
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------