Provider Demographics
NPI:1114677358
Name:CABRERA-GONZALEZ, ISEL
Entity Type:Individual
Prefix:
First Name:ISEL
Middle Name:
Last Name:CABRERA-GONZALEZ
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 1:5130 S PECOS RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-1248
Mailing Address - Country:US
Mailing Address - Phone:702-410-5090
Mailing Address - Fax:702-405-8951
Practice Address - Street 1:5130 S PECOS RD STE 1B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1248
Practice Address - Country:US
Practice Address - Phone:702-410-5090
Practice Address - Fax:702-405-8951
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician