Provider Demographics
NPI:1013599307
Name:CABRAL, ICA DATINGUINOO (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:ICA
Middle Name:DATINGUINOO
Last Name:CABRAL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 THE ALAMEDA STE 615
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2224
Mailing Address - Country:US
Mailing Address - Phone:650-232-4105
Mailing Address - Fax:650-250-5326
Practice Address - Street 1:3130 LA SELVA ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2190
Practice Address - Country:US
Practice Address - Phone:650-232-4105
Practice Address - Fax:650-332-2333
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA814394030OtherN/A