Provider Demographics
NPI:1336198407
Name:CABEZA, RENE (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:CABEZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2776 ENTERPRISE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8316
Mailing Address - Country:US
Mailing Address - Phone:386-774-1223
Mailing Address - Fax:386-774-4658
Practice Address - Street 1:2776 ENTERPRISE RD
Practice Address - Street 2:# 100
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8200
Practice Address - Country:US
Practice Address - Phone:386-774-1223
Practice Address - Fax:386-774-4658
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77058174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255407100Medicaid
FLE2154ZMedicare PIN
FL255407100Medicaid