Provider Demographics
NPI:1558880013
Name:PERLA K CABRERA DDS
Entity Type:Organization
Organization Name:PERLA K CABRERA DDS
Other - Org Name:PERLA K CABRERA DDS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CABRERA LOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:669-913-1565
Mailing Address - Street 1:4275 EXECUTIVE SQUARE STE 200
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9123
Mailing Address - Country:US
Mailing Address - Phone:619-488-3200
Mailing Address - Fax:
Practice Address - Street 1:CIPRES 809
Practice Address - Street 2:FRACC FLAMINGOS
Practice Address - City:MAZATLAN
Practice Address - State:SINALOA
Practice Address - Zip Code:82149
Practice Address - Country:MX
Practice Address - Phone:669-913-1565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ7741904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty