Basic Information
| Provider Information | |||||||||
| NPI: | 1245375955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABRERA | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNP (PNP-PC) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18700 N 64TH DR | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853087109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235615437 | ||||||||
| FaxNumber: | 6235619320 | ||||||||
| Practice Location | |||||||||
| Address1: | 1432 S DOBSON RD STE 403 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852024777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804127718 | ||||||||
| FaxNumber: | 4804127750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | AP4113 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.