Healthcare Provider Details

I. General information

NPI: 1699180117
Provider Name (Legal Business Name): MABEL CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MIDDLESEX LN
YONKERS NY
10710-4301
US

IV. Provider business mailing address

32 MIDDLESEX LN
YONKERS NY
10710-4301
US

V. Phone/Fax

Practice location:
  • Phone: 914-320-0428
  • Fax:
Mailing address:
  • Phone: 914-320-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number684306
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: