Basic Information
| Provider Information | |||||||||
| NPI: | 1467049890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CABRAL | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | SANTOS | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4305 WHITE LN | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933096421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4422856218 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3717 MT PINOS WAY SUITE C & D | ||||||||
| Address2: | |||||||||
| City: | FRAZIER PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612450250 | ||||||||
| FaxNumber: | 6612450252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2020 | ||||||||
| LastUpdateDate: | 12/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 121177 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.