Healthcare Provider Details

I. General information

NPI: 1003458050
Provider Name (Legal Business Name): BRENDA LUCERO CABRERA VILLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 PARK COURT PL BLDG H
SANTA ANA CA
92701-5028
US

IV. Provider business mailing address

833 W STEVENS AVE APT 5
SANTA ANA CA
92707-5009
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-8120
  • Fax:
Mailing address:
  • Phone: 650-995-0516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: