Provider Demographics
NPI:1508480617
Name:CABRERA, ROGELIO R (APRN)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:R
Last Name:CABRERA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15459 SW 143RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6032
Mailing Address - Country:US
Mailing Address - Phone:786-383-8067
Mailing Address - Fax:
Practice Address - Street 1:15529 BULL RUN RD
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7004
Practice Address - Country:US
Practice Address - Phone:305-328-8922
Practice Address - Fax:786-224-6489
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily