MEDICARE: JORGE ANTONIO CABRERA-CARABALLO

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	12701	PR

General Provider Information

NPI Number	:	1689669004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ANTONIO CABRERA-CARABALLO

Provider Business Mailing Address
First Line	:	355 CALLE APONTE
Second Line	:
City	:	SANTURCE
State	:	PR
Zip	:	00912-3614
Country	:	US
Telephone Number	:	787-728-0464
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE CERRA FINAL #900
Second Line	:	CMS DR GUALBERTO RABELL
City	:	SANTURCE
State	:	PR
Zip	:	00907-0000
Country	:	US
Telephone Number	:	787-723-1360
Fax Number	:	787-723-6247

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	03/31/2016

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