Healthcare Provider Details

I. General information

NPI: 1508477019
Provider Name (Legal Business Name): BRENDA CABRERA ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W HILLCREST BLVD
INGLEWOOD CA
90301-2623
US

IV. Provider business mailing address

127 W HILLCREST BLVD
INGLEWOOD CA
90301-2623
US

V. Phone/Fax

Practice location:
  • Phone: 310-706-7725
  • Fax:
Mailing address:
  • Phone: 310-706-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number123112
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: