Healthcare Provider Details

I. General information

NPI: 1457128266
Provider Name (Legal Business Name): YMONETTE CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 PEMBROKE CIR
MEDFORD OR
97504-7722
US

IV. Provider business mailing address

2433 PEMBROKE CIR
MEDFORD OR
97504-7722
US

V. Phone/Fax

Practice location:
  • Phone: 541-324-9156
  • Fax:
Mailing address:
  • Phone: 541-324-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: