Provider Demographics
NPI:1992036602
Name:CABRERA, ELIZABETH
Entity Type:Individual
Prefix:MR
First Name:ELIZABETH
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 STAGECOACH TRAIL LOOP
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2538
Mailing Address - Country:US
Mailing Address - Phone:619-482-5577
Mailing Address - Fax:
Practice Address - Street 1:1275 STAGECOACH TRAIL LOOP
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2538
Practice Address - Country:US
Practice Address - Phone:619-482-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74202183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician