Provider Demographics
NPI:1841047958
Name:CABRERA, KIRSTEN JEAN A
Entity type:Individual
Prefix:
First Name:KIRSTEN JEAN
Middle Name:A
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 1:12235 EAGLE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3844
Mailing Address - Country:US
Mailing Address - Phone:818-585-9218
Mailing Address - Fax:
Practice Address - Street 1:25949 THE OLD RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91381-1714
Practice Address - Country:US
Practice Address - Phone:661-254-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist