Provider Demographics
NPI:1689669004
Name:CABRERA-CARABALLO, JORGE ANTONIO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ANTONIO
Last Name:CABRERA-CARABALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CALLE APONTE
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3614
Mailing Address - Country:US
Mailing Address - Phone:787-728-0464
Mailing Address - Fax:
Practice Address - Street 1:CALLE CERRA FINAL #900
Practice Address - Street 2:CMS DR GUALBERTO RABELL
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-0000
Practice Address - Country:US
Practice Address - Phone:787-723-1360
Practice Address - Fax:787-723-6247
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12701208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice