1992174122 NPI number — LAUREN CABRERA NP

Table of content: LAUREN CABRERA NP (NPI 1992174122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992174122 NPI number — LAUREN CABRERA NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABRERA
Provider First Name:
LAUREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CERULLI AND CARTER AND DOYLE
Provider Other First Name:
LAUREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992174122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1270 N. MARINE CORPS DR. STE 101-757
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96913-4331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-707-7115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 ROUTE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDEDO
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96929-6911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-645-5546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RE2378 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: AP60659246 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: RN60659245 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 307499 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: NP0176 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2069834 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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