Basic Information
| Provider Information | |||||||||
| NPI: | 1174669246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABRERA | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25098 OLYMPIA AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416216771 | ||||||||
| FaxNumber: | 9416216774 | ||||||||
| Practice Location | |||||||||
| Address1: | 25098 OLYMPIA AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416216771 | ||||||||
| FaxNumber: | 9416216774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 05/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01062240A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME115384 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QB0002X | ME115384 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine |
No ID Information.