Provider Demographics
NPI:1477679355
Name:CABRERA, KIMIYE RF (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMIYE
Middle Name:RF
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 1:2700 E 29TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2507
Mailing Address - Country:US
Mailing Address - Phone:979-776-5631
Mailing Address - Fax:979-776-6184
Practice Address - Street 1:2700 E 29TH ST STE 105
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2507
Practice Address - Country:US
Practice Address - Phone:979-776-5631
Practice Address - Fax:979-776-6184
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 15339R208600000X
TXP1625208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ926800Medicaid
AZI28677Medicare UPIN
AZ8HD637Medicare ID - Type UnspecifiedMEDICARE PART B - CHINLE
AZ926800Medicaid
AZ8HD638Medicare ID - Type UnspecifiedMEDICARE PART B - PINON