Provider Demographics
NPI:1013474485
Name:CABANILLAS, ANDREW DANIEL (RBT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DANIEL
Last Name:CABANILLAS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10362 E 39TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-7234
Mailing Address - Country:US
Mailing Address - Phone:928-919-3983
Mailing Address - Fax:
Practice Address - Street 1:2741 S 8TH AVE STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7154
Practice Address - Country:US
Practice Address - Phone:928-782-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-19-77750106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician