Provider Demographics
NPI:1700603347
Name:CABRAL, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CABRAL
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 1:11268 WINGATE DR
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9119
Mailing Address - Country:US
Mailing Address - Phone:951-202-2285
Mailing Address - Fax:
Practice Address - Street 1:4060 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3537
Practice Address - Country:US
Practice Address - Phone:909-470-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health