Healthcare Provider Details

I. General information

NPI: 1346105517
Provider Name (Legal Business Name): HAIDE CABRERA- VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MANHATTAN AVE
MIDDLETOWN NY
10940-6227
US

IV. Provider business mailing address

4 MANHATTAN AVE
MIDDLETOWN NY
10940-6227
US

V. Phone/Fax

Practice location:
  • Phone: 858-222-7604
  • Fax:
Mailing address:
  • Phone: 858-222-7604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number354089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: