Healthcare Provider Details

I. General information

NPI: 1609915917
Provider Name (Legal Business Name): PAUL CABRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date: 08/03/2022
Reactivation Date: 09/23/2025

III. Provider practice location address

4514 HUNTINGTON DR S
LOS ANGELES CA
90032-1913
US

IV. Provider business mailing address

19197 GOLDEN VALLEY RD STE 103
SANTA CLARITA CA
91387-1486
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95041700
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041700
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95041700
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30464
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95217941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: