Healthcare Provider Details

I. General information

NPI: 1366195158
Provider Name (Legal Business Name): VICKI CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31764 CASINO DR STE 300
LAKE ELSINORE CA
92530-2312
US

IV. Provider business mailing address

31764 CASINO DR STE 300
LAKE ELSINORE CA
92530-2312
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-4645
  • Fax:
Mailing address:
  • Phone: 951-471-4645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-TMJZAI
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: