1245375955 NPI number — MS. ANGELA J CABRERA CRNP (PNP-PC)

Table of content: MS. ANGELA J CABRERA CRNP (PNP-PC) (NPI 1245375955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245375955 NPI number — MS. ANGELA J CABRERA CRNP (PNP-PC)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABRERA
Provider First Name:
ANGELA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP (PNP-PC)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245375955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18700 N 64TH DR
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-7109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-561-5437
Provider Business Mailing Address Fax Number:
623-561-9320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1432 S DOBSON RD STE 403
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85202-4777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-412-7718
Provider Business Practice Location Address Fax Number:
480-412-7750
Provider Enumeration Date:
02/20/2007

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: 363LP0200X , with the licence number:  AP4113 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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