Provider Demographics
NPI:1356753115
Name:CABRERA, SOFIA (RN)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MINOT ST
Mailing Address - Street 2:APT 2
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 MINOT ST
Practice Address - Street 2:APT 2
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5117
Practice Address - Country:US
Practice Address - Phone:845-709-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY681361163W00000X
MARN2305502163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse