Healthcare Provider Details

I. General information

NPI: 1255266250
Provider Name (Legal Business Name): MARIAH RENEE CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11799 SEBASTIAN WAY STE 103
RANCHO CUCAMONGA CA
91730-0708
US

IV. Provider business mailing address

46400 DUNE PALMS RD SPC 77
LA QUINTA CA
92253-4040
US

V. Phone/Fax

Practice location:
  • Phone: 800-465-3203
  • Fax:
Mailing address:
  • Phone: 760-702-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: