Provider Demographics
NPI:1205848546
Name:CABRERA, MARLYN L (MD)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:L
Last Name:CABRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7254 BLANCO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4930
Mailing Address - Country:US
Mailing Address - Phone:210-901-9499
Mailing Address - Fax:210-247-9499
Practice Address - Street 1:7254 BLANCO RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4930
Practice Address - Country:US
Practice Address - Phone:210-901-9499
Practice Address - Fax:210-247-9499
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89610XOtherBC/BS OF TEXAS
TX101867306Medicaid
315808ZAEAOtherMEDICARE
TX101867302Medicaid
TX101867307Medicaid
TXG99384Medicare UPIN