Provider Demographics
NPI:1710626734
Name:CABEZAS, ANA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:CABEZAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 BEACH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-8968
Mailing Address - Country:US
Mailing Address - Phone:805-242-6797
Mailing Address - Fax:
Practice Address - Street 1:1530 MONTEREY ST STE A
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2969
Practice Address - Country:US
Practice Address - Phone:407-403-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist