Provider Demographics
NPI:1912988668
Name:DEL ROSARIO CABRAL, LUIS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:DEL ROSARIO CABRAL
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 1:1535 W NASA BLVD STE 103
Mailing Address - Street 2:BUILDING C
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2635
Mailing Address - Country:US
Mailing Address - Phone:321-837-0010
Mailing Address - Fax:321-837-0040
Practice Address - Street 1:1535 W NASA BLVD STE 103
Practice Address - Street 2:BUILDING C
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2635
Practice Address - Country:US
Practice Address - Phone:321-837-0010
Practice Address - Fax:321-837-0040
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88009207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
48142OtherBCBS FL
FL270094800Medicaid
48142WMedicare PIN
H15885Medicare UPIN