Healthcare Provider Details

I. General information

NPI: 1285011387
Provider Name (Legal Business Name): RICHARD FABIAN CABRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 MAGNOLIA AVE
RIVERSIDE CA
92503-3528
US

IV. Provider business mailing address

101 E BEVERLY BLVD STE 301
MONTEBELLO CA
90640-4316
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-8802
  • Fax: 951-687-2250
Mailing address:
  • Phone: 951-354-3216
  • Fax: 951-848-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number150290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: