MEDICARE: JUAN ANTONIO ALFONSO CABRERA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	023425	PR

General Provider Information

NPI Number	:	1407584683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN ANTONIO ALFONSO CABRERA MD

Provider Business Mailing Address
First Line	:	5920 METROPOLIS WAY STE 1
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2705
Country	:	US
Telephone Number	:	844-665-4827
Fax Number	:	855-540-0677

Provider Business Practice Location Address
First Line	:	5920 METROPOLIS WAY STE 101
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2706
Country	:	US
Telephone Number	:	844-665-4827
Fax Number	:	855-540-0677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	03/06/2024

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