Provider Demographics
NPI:1689319493
Name:CABRERA, CARLOS MANUEL
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:CABRERA
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 1:81 PETERSON CT
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2983
Mailing Address - Country:US
Mailing Address - Phone:732-507-2819
Mailing Address - Fax:
Practice Address - Street 1:81 PETERSON CT
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2983
Practice Address - Country:US
Practice Address - Phone:732-507-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJC00201107405012172A00000X
2279P4000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P4000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPatient Transport
No172A00000XOther Service ProvidersDriver