Healthcare Provider Details

I. General information

NPI: 1467049890
Provider Name (Legal Business Name): JONATHAN SANTOS CABRAL LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 02/20/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 HALL RD
LAMONT CA
93241-1953
US

IV. Provider business mailing address

8787 HALL RD
LAMONT CA
93241-1953
US

V. Phone/Fax

Practice location:
  • Phone: 661-845-3731
  • Fax: 661-845-1157
Mailing address:
  • Phone: 661-845-3731
  • Fax: 661-845-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT142150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: