Healthcare Provider Details

I. General information

NPI: 1417320144
Provider Name (Legal Business Name): DAVID CABRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 07/10/2023
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3541 CHAIN BRIDGE RD STE 204
FAIRFAX VA
22030-2793
US

IV. Provider business mailing address

3541 CHAIN BRIDGE RD STE 204
FAIRFAX VA
22030-2793
US

V. Phone/Fax

Practice location:
  • Phone: 703-218-6599
  • Fax: 703-218-2012
Mailing address:
  • Phone: 877-823-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: