Provider Demographics
NPI:1073850012
Name:CABREJOS, LISA BLOMBERG (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BLOMBERG
Last Name:CABREJOS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4363 DONALD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3812
Mailing Address - Country:US
Mailing Address - Phone:619-838-2340
Mailing Address - Fax:
Practice Address - Street 1:9620 CHESAPEAKE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1369
Practice Address - Country:US
Practice Address - Phone:858-859-5369
Practice Address - Fax:858-541-2600
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8627225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist