Provider Demographics
NPI:1902893316
Name:CABRERA, CARLOS A (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:CABRERA
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:RR 1 BOX 11774
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-9721
Mailing Address - Country:US
Mailing Address - Phone:787-884-5584
Mailing Address - Fax:787-884-5584
Practice Address - Street 1:RR 1 BOX 11774
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-9721
Practice Address - Country:US
Practice Address - Phone:787-884-5584
Practice Address - Fax:787-884-5584
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG99098Medicare UPIN
PR90189Medicare ID - Type Unspecified