Provider Demographics
NPI:1437354198
Name:CABRERA, GUILLERMO RAFAEL (DC)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:RAFAEL
Last Name:CABRERA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W CENTRAL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3100
Mailing Address - Country:US
Mailing Address - Phone:714-979-9296
Mailing Address - Fax:
Practice Address - Street 1:1155 W CENTRAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3100
Practice Address - Country:US
Practice Address - Phone:714-979-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor