Provider Demographics
NPI:1407989726
Name:CABRERA, JOSE (MA, ATR-BC,)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CABRERA
Suffix:
Gender:M
Credentials:MA, ATR-BC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 SANTA MONICA BLVD APT 22
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2551
Mailing Address - Country:US
Mailing Address - Phone:310-350-3729
Mailing Address - Fax:
Practice Address - Street 1:8722 DELGANY AVE
Practice Address - Street 2:APT 22
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8190
Practice Address - Country:US
Practice Address - Phone:310-350-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45195106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist