Provider Demographics
NPI:1003458050
Name:CABRERA VILLAR, BRENDA LUCERO
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LUCERO
Last Name:CABRERA VILLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 W STEVENS AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5009
Mailing Address - Country:US
Mailing Address - Phone:650-995-0516
Mailing Address - Fax:
Practice Address - Street 1:1801 PARK COURT PL BLDG H
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5028
Practice Address - Country:US
Practice Address - Phone:510-268-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information