Provider Demographics
NPI:1003086364
Name:CABRERA, JASMIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JASMIN
Middle Name:R
Last Name:CABRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JASMIN
Other - Middle Name:E
Other - Last Name:ROXAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3740 UTICA RIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1657
Mailing Address - Country:US
Mailing Address - Phone:563-344-7400
Mailing Address - Fax:563-359-9395
Practice Address - Street 1:3740 UTICA RIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1657
Practice Address - Country:US
Practice Address - Phone:563-344-7400
Practice Address - Fax:563-359-9395
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.119880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119880Medicaid
IA72295OtherWELLMARK
IA37559OtherSTATE OF IOWA
IL036.119880OtherSTATE LICENSE
IA349150OtherCOVENTRY
IA349150OtherCOVENTRY
IL036119880Medicaid