Provider Demographics
NPI:1407866486
Name:SOLLA-CABRERA, ODETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ODETTE
Middle Name:
Last Name:SOLLA-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 1:320 BOLTON ST
Mailing Address - Street 2:MARLBORO PEDIATRICS
Mailing Address - City:MARLBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:508-460-9670
Mailing Address - Fax:
Practice Address - Street 1:320 BOLTON ST
Practice Address - Street 2:MARLBORO PEDIATRICS
Practice Address - City:MARLBORO
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-460-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59542208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB10057801OtherCIGNA
MA715661OtherTUFTS HMO
MA3064573Medicaid
MA20691OtherHARVARD PILGRIM
MAJ10340OtherBLUE CROSS
E04019Medicare UPIN