Healthcare Provider Details

I. General information

NPI: 1124907365
Provider Name (Legal Business Name): ALVIN LEE CABRERA CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35420 REDBERRY PALMS CT
LAKE ELSINORE CA
92532-2901
US

IV. Provider business mailing address

35420 REDBERRY PALMS CT
LAKE ELSINORE CA
92532-2901
US

V. Phone/Fax

Practice location:
  • Phone: 626-374-4784
  • Fax:
Mailing address:
  • Phone: 626-374-4784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: