Provider Demographics
NPI:1386971364
Name:CABEZAS, MANUEL EDGARDO (HHP)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:EDGARDO
Last Name:CABEZAS
Suffix:
Gender:M
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 ARVINELS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2324
Mailing Address - Country:US
Mailing Address - Phone:858-229-7479
Mailing Address - Fax:
Practice Address - Street 1:4980 ARVINELS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-2324
Practice Address - Country:US
Practice Address - Phone:858-229-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB1995000055174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB1995000055OtherHOLISTIC HEALTH PRACTITIONER