Provider Demographics
NPI:1982784120
Name:FERNANDEZ CABRERO, AGUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:
Last Name:FERNANDEZ CABRERO
Suffix:
Gender:M
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:PO BOX 7004
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:787-842-0230
Mailing Address - Fax:787-284-3619
Practice Address - Street 1:ANA D PEIS MARSHAND ST LOTE 2 BYPASS
Practice Address - Street 2:URB INDUSTRIAL RESORADA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-840-0052
Practice Address - Fax:787-840-2317
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6019207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D26707Medicare UPIN
PR98426Medicare ID - Type Unspecified