Healthcare Provider Details

I. General information

NPI: 1740125657
Provider Name (Legal Business Name): ANNIE CABUGOS HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W J ST STE A
LOS BANOS CA
93635-3414
US

IV. Provider business mailing address

1343 W MAIN ST
MERCED CA
95340-4438
US

V. Phone/Fax

Practice location:
  • Phone: 209-704-6556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number733782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: