Provider Demographics
NPI:1275204737
Name:HERNANDEZ CABRERA, JAQUELINNE
Entity Type:Individual
Prefix:
First Name:JAQUELINNE
Middle Name:
Last Name:HERNANDEZ CABRERA
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 1:12846 MORNING BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4606
Mailing Address - Country:US
Mailing Address - Phone:888-611-0870
Mailing Address - Fax:888-714-4996
Practice Address - Street 1:1127 S RANCHO DR STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2216
Practice Address - Country:US
Practice Address - Phone:888-611-0870
Practice Address - Fax:888-714-4996
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-21-178855106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician