Basic Information
| Provider Information | |||||||||
| NPI: | 1104114958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CABRERA | ||||||||
| FirstName: | KARELY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 417 | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349950417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722322832 | ||||||||
| FaxNumber: | 7727812792 | ||||||||
| Practice Location | |||||||||
| Address1: | 3066 SW MARTIN DOWNS BLVD | ||||||||
| Address2: | |||||||||
| City: | PALM CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349902683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7727812791 | ||||||||
| FaxNumber: | 7727812792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2011 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 76479 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | ME133060 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 023105200 | 05 | FL | MEDICAID |