Healthcare Provider Details

I. General information

NPI: 1396464301
Provider Name (Legal Business Name): KEVIN ALEXANDER CABRERA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 CONVOY CT FL 2
SAN DIEGO CA
92111-1014
US

IV. Provider business mailing address

6911 CONVOY CT FL 2
SAN DIEGO CA
92111-1014
US

V. Phone/Fax

Practice location:
  • Phone: 623-572-3200
  • Fax:
Mailing address:
  • Phone: 858-266-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A23914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: