Provider Demographics
NPI:1467682112
Name:CABRERA, DONALD JR
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:CABRERA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 BENITO ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2852
Mailing Address - Country:US
Mailing Address - Phone:909-237-0312
Mailing Address - Fax:
Practice Address - Street 1:5206 BENITO ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2852
Practice Address - Country:US
Practice Address - Phone:909-237-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75105261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health