Provider Demographics
NPI:1154585446
Name:CABRERA, MARY ANN (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:CABRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 SE WILLOUGHBY BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5060
Mailing Address - Country:US
Mailing Address - Phone:772-221-4000
Mailing Address - Fax:772-221-4989
Practice Address - Street 1:3441 SE WILLOUGHBY BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5060
Practice Address - Country:US
Practice Address - Phone:772-221-4000
Practice Address - Fax:772-221-4989
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101518207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000393300Medicaid
FLAM018UMedicare UPIN