Individual provider Active NPI

Mariella J Cabrera Quijada, MD

  • Pediatrics Physician
  • Deltona, FL
National Provider Identifier
1578098976
Registry record updated May 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME143374 Issued in FL
Practice address
596 Courtland Blvd
Deltona, FL 32738-8902
Phone
(407) 249-1234
Fax
(407) 249-1755
NPI assigned
Apr 24, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME143374 FL Primary

Addresses

Primary practice location

596 Courtland Blvd
Deltona, FL 32738-8902

Mailing address

1651 N Semoran Blvd
Orlando, FL 32807-3575
Phone (407) 249-1234

Other identifiers 1

IdentifierTypeStateIssuer
105401200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME143374FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saltzman, Tanis, Pittell, Levin and Jacobson Pediatrics Past Accepting new patients
Saltzman, Tanis, Pittel, Levin and Jacobson, LLC Pediatrics PastSince Mar 27, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1578098976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1651 N SEMORAN BLVD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328073575",
            "telephone_number": "407-249-1234",
            "fax_number": "407-249-1755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 COURTLAND BLVD",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327388902",
            "telephone_number": "407-249-1234",
            "fax_number": "407-249-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CABRERA QUIJADA",
        "first_name": "MARIELLA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-24",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME143374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105401200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deltona, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.