Provider Demographics
NPI:1568574523
Name:CUBILLAS, MARIA CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARMEN
Last Name:CUBILLAS
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 1:27531 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8225
Mailing Address - Country:US
Mailing Address - Phone:305-246-0047
Mailing Address - Fax:305-247-8540
Practice Address - Street 1:27531 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8225
Practice Address - Country:US
Practice Address - Phone:305-246-0047
Practice Address - Fax:305-247-8540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055442207Q00000X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061802100Medicaid
FL061802100Medicaid
FLE41734Medicare UPIN