Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036.119880 | IL |
NPI | 1003086364 |
---|---|
Provider Name | Dr. Jasmin R Cabrera |
First Address | Bettendorf, IA 52722-1657 |
Second Address | Bettendorf, IA 52722-1657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2008 |
Last Update Date | 14/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.119880 | STATE LICENSE (01) | IL |
036119880 | (05) | IL |
349150 | COVENTRY (01) | IA |
37559 | STATE OF IOWA (01) | IA |
72295 | WELLMARK (01) | IA |