Provider Demographics
NPI:1306083241
Name:CABRERA, IVAN ENZO (BS)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:ENZO
Last Name:CABRERA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18246 BATHURST ST
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2023
Mailing Address - Country:US
Mailing Address - Phone:818-614-4150
Mailing Address - Fax:
Practice Address - Street 1:18246 BATHURST ST
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2023
Practice Address - Country:US
Practice Address - Phone:818-614-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner