Provider Demographics
NPI:1205258696
Name:CABRERA, JONATHAN SALAMANES (BSN, CDC-1, MS, MAC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SALAMANES
Last Name:CABRERA
Suffix:
Gender:M
Credentials:BSN, CDC-1, MS, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SAN JERONIMO DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2870
Mailing Address - Country:US
Mailing Address - Phone:907-793-3600
Mailing Address - Fax:
Practice Address - Street 1:30881 EKLUTNA LAKE RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5166
Practice Address - Country:US
Practice Address - Phone:907-688-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4205101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021028Medicaid