Provider Demographics
NPI:1104309830
Name:CABRAL, GINA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:CABRAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:MIRARCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:253 10TH AVE UNIT 907
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7464
Mailing Address - Country:US
Mailing Address - Phone:619-813-9796
Mailing Address - Fax:
Practice Address - Street 1:3511 CAMINO DEL RIO S STE 303
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4043
Practice Address - Country:US
Practice Address - Phone:619-630-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist