MEDICARE: MS. ANGELA J CABRERA CRNP (PNP-PC)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	AP4113	AZ

General Provider Information

NPI Number	:	1245375955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA J CABRERA CRNP (PNP-PC)

Provider Business Mailing Address
First Line	:	18700 N 64TH DR
Second Line	:	SUITE 301
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7109
Country	:	US
Telephone Number	:	623-561-5437
Fax Number	:	623-561-9320

Provider Business Practice Location Address
First Line	:	1432 S DOBSON RD STE 403
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-4777
Country	:	US
Telephone Number	:	480-412-7718
Fax Number	:	480-412-7750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/07/2020

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