Healthcare Provider Details

I. General information

NPI: 1760931737
Provider Name (Legal Business Name): MIGUEL ANGEL CABRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N KAWEAH AVE
EXETER CA
93221-1200
US

IV. Provider business mailing address

516 N KAWEAH AVE
EXETER CA
93221-1200
US

V. Phone/Fax

Practice location:
  • Phone: 595-944-9695
  • Fax:
Mailing address:
  • Phone: 559-594-4969
  • Fax: 559-594-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: