Provider Demographics
NPI:1700196508
Name:CABRERA, CONCHITA MAGDALENA
Entity Type:Individual
Prefix:
First Name:CONCHITA
Middle Name:MAGDALENA
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 1:9445 FARNHAM ST.
Mailing Address - Street 2:STE: 100 TBS-SD LOCATION
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-380-4669
Mailing Address - Fax:
Practice Address - Street 1:9445 FARNHAM ST.
Practice Address - Street 2:STE: 100 TBS-SD LOCATION
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-9445
Practice Address - Country:US
Practice Address - Phone:858-380-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health