Provider Demographics
NPI:1366524498
Name:CABRERA, LAURA BEATRICE (PT COMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BEATRICE
Last Name:CABRERA
Suffix:
Gender:F
Credentials:PT COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1927
Mailing Address - Country:US
Mailing Address - Phone:510-508-9752
Mailing Address - Fax:
Practice Address - Street 1:1055 SUNNYVALE SARATOGA RD
Practice Address - Street 2:SUITE 6
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2500
Practice Address - Country:US
Practice Address - Phone:408-774-1424
Practice Address - Fax:408-774-0851
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT26160Medicare ID - Type UnspecifiedPHYSICAL THERAPIST