Healthcare Provider Details

I. General information

NPI: 1295418887
Provider Name (Legal Business Name): LUIS DAVID CABANILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45111 FERN AVE
LANCASTER CA
93534-2301
US

IV. Provider business mailing address

2845 W NEWGROVE ST
LANCASTER CA
93536-1423
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-1206
  • Fax:
Mailing address:
  • Phone: 661-429-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18690
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: