1205019270 NPI number — ERNESTO CABRERA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205019270 NPI number — ERNESTO CABRERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERNESTO CABRERA MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205019270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1431 N WESTERN AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-489-6605
Provider Business Mailing Address Fax Number:
312-633-5863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 N WESTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-489-6605
Provider Business Practice Location Address Fax Number:
312-633-5863
Provider Enumeration Date:
12/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
MARISSA
Authorized Official Middle Name:
SAYSON
Authorized Official Title or Position:
MEDICAL ASSISTANT
Authorized Official Telephone Number:
773-489-6605

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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