MEDICARE: ANGELICA CABRAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	14-1268	NV

General Provider Information

NPI Number	:	1780077644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA CABRAL

Provider Business Mailing Address
First Line	:	6773 BOCCELLI CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6768
Country	:	US
Telephone Number	:	702-515-9677
Fax Number	:

Provider Business Practice Location Address
First Line	:	6166 N DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3912
Country	:	US
Telephone Number	:	725-223-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	06/09/2020

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