Provider Demographics
NPI:1255318986
Name:DE THOMAS-CABRERA, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:DE THOMAS-CABRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AVE FD ROOSEVELT
Mailing Address - Street 2:CLINICA LAS AMERICAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2129
Mailing Address - Country:US
Mailing Address - Phone:787-765-7713
Mailing Address - Fax:787-250-7967
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:CLINICA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2129
Practice Address - Country:US
Practice Address - Phone:787-765-7713
Practice Address - Fax:787-250-7967
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0110262085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR008-7934Medicare ID - Type Unspecified
PRF67588Medicare UPIN