Provider Demographics
NPI:1104220714
Name:CABRERA, JOSE MIGUEL
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MIGUEL
Last Name:CABRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1717
Mailing Address - Country:US
Mailing Address - Phone:650-853-3188
Mailing Address - Fax:650-853-5928
Practice Address - Street 1:2277 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1717
Practice Address - Country:US
Practice Address - Phone:650-853-3188
Practice Address - Fax:650-853-5928
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker