Provider Demographics
NPI:1033358221
Name:ERIK .D . CABRERA A PROFESINAL DENTAL CORP.
Entity Type:Organization
Organization Name:ERIK .D . CABRERA A PROFESINAL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:D
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-236-0639
Mailing Address - Street 1:14435 MORENO BEACH DRIVE
Mailing Address - Street 2:108A
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-1443
Mailing Address - Country:US
Mailing Address - Phone:951-247-6000
Mailing Address - Fax:951-247-6114
Practice Address - Street 1:14435 MORENO BEACH DR
Practice Address - Street 2:108 A
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555
Practice Address - Country:US
Practice Address - Phone:951-247-6000
Practice Address - Fax:951-247-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty