Provider Demographics
NPI:1316600414
Name:MARTHA CABRALES
Entity Type:Organization
Organization Name:MARTHA CABRALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-816-2312
Mailing Address - Street 1:4492 CAMINO DE LA PLAZA
Mailing Address - Street 2:462
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173
Mailing Address - Country:US
Mailing Address - Phone:619-816-2312
Mailing Address - Fax:
Practice Address - Street 1:AV COSTITUCION ESQUINA SEXTA
Practice Address - Street 2:1235
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:619-209-8924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTHA CABRALES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-16
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty