Provider Demographics
NPI:1558638726
Name:CABRERA, JORGE
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CABRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84110
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0018
Mailing Address - Country:US
Mailing Address - Phone:713-440-6700
Mailing Address - Fax:866-867-7395
Practice Address - Street 1:13529 S POST OAK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-4007
Practice Address - Country:US
Practice Address - Phone:713-440-6700
Practice Address - Fax:866-867-7395
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0033221247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087340801Medicaid
TX016097001Medicaid
TX218050701Medicaid
TX218050702Medicaid
TX0497360001Medicare NSC
TX087340801Medicaid