Provider Demographics
NPI:1477037828
Name:CABULA, MARIA LOURDES (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
Last Name:CABULA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 W AVENUE 30
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1303
Mailing Address - Country:US
Mailing Address - Phone:213-265-4106
Mailing Address - Fax:
Practice Address - Street 1:2807 W AVENUE 30
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-1303
Practice Address - Country:US
Practice Address - Phone:213-265-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA676767163WG0000X
CA95010421363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF09180155OtherAANP