Provider Demographics
NPI:1407584683
Name:ALFONSO CABRERA, JUAN ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:ALFONSO CABRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5920 METROPOLIS WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2705
Mailing Address - Country:US
Mailing Address - Phone:844-665-4827
Mailing Address - Fax:855-540-0677
Practice Address - Street 1:5920 METROPOLIS WAY STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2706
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:855-540-0677
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR023425208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice