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General NPI Number Information
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NPI Number | 1891883484
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PROVIDERS OF S. FLA
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 464 W 51ST PL
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City | HIALEAH
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State | FL
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Zip | 33012-3620
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Country | US
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Telephone | 305-557-1281
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Fax | 305-362-9138
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Provider Business Mailing Address
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Address Line | 464 W 51ST PL
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City | HIALEAH
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State | FL
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Zip | 33012-3620
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Country | US
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Telephone | 305-557-1281
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Fax | 305-362-9138
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Authorized Official
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Title or Position | OWNER
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Name | DR. JORGE LUIS CABRERA
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Credential | M.D.
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Telephone | 305-557-1281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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