Healthcare Provider Details

I. General information

NPI: 1952214512
Provider Name (Legal Business Name): IRENE CABANILLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 EAST WASHINGTON AVENUE
EARLIMART CA
93219
US

IV. Provider business mailing address

PO BOX 11707
EARLIMART CA
93219-1707
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: