Provider Demographics
NPI:1619357902
Name:MARIA L FUNDORA CABRERA DPM PA
Entity type:Organization
Organization Name:MARIA L FUNDORA CABRERA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUNDORA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-554-7996
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4709
Mailing Address - Country:US
Mailing Address - Phone:904-554-7996
Mailing Address - Fax:
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4709
Practice Address - Country:US
Practice Address - Phone:305-945-7575
Practice Address - Fax:305-945-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty