Provider Demographics
NPI:1568658482
Name:CABRAL, DEXTER DANCEL
Entity Type:Individual
Prefix:
First Name:DEXTER
Middle Name:DANCEL
Last Name:CABRAL
Suffix:
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 1:310 LADERA LANE SUITE 908
Mailing Address - Street 2:
Mailing Address - City:MANGILAO
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-339-7118
Mailing Address - Fax:
Practice Address - Street 1:PSC 490 BOX 7607
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538
Practice Address - Country:US
Practice Address - Phone:671-339-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman