Provider Demographics
NPI:1760931737
Name:CABRERA, MIGUEL ANGEL
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:CABRERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N KAWEAH AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1200
Mailing Address - Country:US
Mailing Address - Phone:559-594-4969
Mailing Address - Fax:559-594-4969
Practice Address - Street 1:516 N KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1200
Practice Address - Country:US
Practice Address - Phone:595-944-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128399104100000X, 1041C0700X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program