Provider Demographics
NPI:1962293654
Name:CABRERA PINA, FANNY (RND, LDN, CBS)
Entity type:Individual
Prefix:
First Name:FANNY
Middle Name:
Last Name:CABRERA PINA
Suffix:
Gender:F
Credentials:RND, LDN, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 JERICHO AVE
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-9739
Mailing Address - Country:US
Mailing Address - Phone:787-364-7607
Mailing Address - Fax:
Practice Address - Street 1:5423 JERICHO AVE
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:FL
Practice Address - Zip Code:33868-9739
Practice Address - Country:US
Practice Address - Phone:787-364-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1893133N00000X
FL7882133N00000X, 133NN1002X
FL174N00000X
FL86010408133V00000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174N00000XOther Service ProvidersLactation Consultant, Non-RN