Provider Demographics
NPI:1831473560
Name:CABRAL, BRENDA ELIZA C (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELIZA C
Last Name:CABRAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-0816
Mailing Address - Country:US
Mailing Address - Phone:650-697-2376
Mailing Address - Fax:
Practice Address - Street 1:77 N SAN MATEO DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2889
Practice Address - Country:US
Practice Address - Phone:650-343-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist