Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT35308 | CA |
NPI | 1003108036 |
---|---|
Provider Name | Ronaldo Cabrera |
First Address | Cypress, CA 90630-3109 |
Second Address | Fullerton, CA 92831-4102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 10/05/2011 |