Provider Demographics
NPI:1801937107
Name:CABRERA, EDWIN HUMBERTO (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:HUMBERTO
Last Name:CABRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 TOMPAU PL
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-2893
Mailing Address - Country:US
Mailing Address - Phone:619-659-0534
Mailing Address - Fax:
Practice Address - Street 1:2615 TOMPAU PL
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-2893
Practice Address - Country:US
Practice Address - Phone:619-659-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29706Medicare UPIN
CAA43556Medicare ID - Type Unspecified