Provider Demographics
NPI:1558616227
Name:JORGE L. CABRERA, M.D., P.A.
Entity Type:Organization
Organization Name:JORGE L. CABRERA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-621-9777
Mailing Address - Street 1:175 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3711
Mailing Address - Country:US
Mailing Address - Phone:786-621-9777
Mailing Address - Fax:786-621-9601
Practice Address - Street 1:175 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3711
Practice Address - Country:US
Practice Address - Phone:786-621-9777
Practice Address - Fax:786-621-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057-143-100Medicaid
FL006-500-500OtherMEDICAID GROUP