Provider Demographics
NPI:1255091138
Name:CABRERA, MERVIN (PA)
Entity type:Individual
Prefix:
First Name:MERVIN
Middle Name:
Last Name:CABRERA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 WESTLAWN AVE APT 330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7081
Mailing Address - Country:US
Mailing Address - Phone:209-244-8249
Mailing Address - Fax:
Practice Address - Street 1:2020 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-3120
Practice Address - Country:US
Practice Address - Phone:916-341-0575
Practice Address - Fax:916-341-0122
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant