Provider Demographics
NPI:1235254483
Name:CABRERA, JOSHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:CABRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E 29TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2622
Mailing Address - Country:US
Mailing Address - Phone:979-774-8200
Mailing Address - Fax:979-776-6905
Practice Address - Street 1:2900 E 29TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2622
Practice Address - Country:US
Practice Address - Phone:979-774-8200
Practice Address - Fax:979-776-6905
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 15229R2084P0800X
TXP40302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326386501Medicaid
AZ957235Medicaid
AZI25656Medicare UPIN
TX326386501Medicaid
AZ8HE249Medicare ID - Type UnspecifiedMEDICARE PART B - PINON
AZ8HE248Medicare ID - Type UnspecifiedMEDICARE PART B - CHINLE
AZ8HE250Medicare ID - Type UnspecifiedMEDICARE PART B - TSAILE