Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 02309 | PR |
NPI | 1003966953 |
---|---|
Provider Name | Dr. Pedro Gilberto Cabrera |
First Address | Manati, PR 00674-5507 |
Second Address | Manati, PR 00674-5507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |