Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 40912 |
NPI | 1235764697 |
---|---|
Provider Name | Alex Cabrera |
First Address | Rancho Santa Margarita, CA 92688-1409 |
Second Address | Rancho Santa Margarita, CA 92688-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2020 |
Last Update Date | 05/03/2020 |