Healthcare Provider Details

I. General information

NPI: 1760218911
Provider Name (Legal Business Name): NEREYDA CABRERA RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 THIRD AVE STE C3
CHULA VISTA CA
91911-3139
US

IV. Provider business mailing address

33790 SHOCKEY TRUCK TRL
CAMPO CA
91906-3226
US

V. Phone/Fax

Practice location:
  • Phone: 619-691-8164
  • Fax:
Mailing address:
  • Phone: 619-495-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1563290624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: