Provider Demographics
NPI:1104113547
Name:CABRERA, ROBERTO (HAS)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:CABRERA
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 BONNEVAL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7565
Mailing Address - Country:US
Mailing Address - Phone:904-296-0098
Mailing Address - Fax:904-861-3899
Practice Address - Street 1:12341 YELLOW BLUFF RD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2014
Practice Address - Country:US
Practice Address - Phone:904-296-0098
Practice Address - Fax:904-696-3422
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4383237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist