Basic Information
| Provider Information | |||||||||
| NPI: | 1205019270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ERNESTO CABRERA MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1431 N WESTERN AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734896605 | ||||||||
| FaxNumber: | 3126335863 | ||||||||
| Practice Location | |||||||||
| Address1: | 1431 N WESTERN AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734896605 | ||||||||
| FaxNumber: | 3126335863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | FERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | MARISSA | ||||||||
| AuthorizedOfficialMiddleName: | SAYSON | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7734896605 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MEDICAL ASSISTANT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.