Basic Information
| Provider Information | |||||||||
| NPI: | 1518563188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABRERA | ||||||||
| FirstName: | FATIMA | ||||||||
| MiddleName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 296 HEATHCOTE RD | ||||||||
| Address2: | |||||||||
| City: | LINDENHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117571742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3478374130 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5913 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113852647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464560819 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2020 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.