=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952712200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CABRERA & SHERE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2014
-----------------------------------------------------
Last Update Date | 05/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6318 FM 1488 RD STE 120
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77354-2763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-899-1789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11014 LINDEN GATE DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77075-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RODRIGO CABRERA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 713-899-1789
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 23862
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------