Basic Information
| Provider Information | |||||||||
| NPI: | 1295742377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABRERA | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 PLAZA EAST BLVD STE 303 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477152871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124791511 | ||||||||
| FaxNumber: | 8124731035 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PLAZA EAST BLVD STE 303 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477152871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124731307 | ||||||||
| FaxNumber: | 8124731035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | 01038887 | IN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 200002820B | 05 | IN | MEDICAID |