Provider Demographics
NPI:1235984378
Name:CABRERA LOPEZ, JAZMIN ALINA
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:ALINA
Last Name:CABRERA LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 CLOVERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1305
Mailing Address - Country:US
Mailing Address - Phone:626-391-2762
Mailing Address - Fax:
Practice Address - Street 1:1325 CLOVERGLEN DR
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1305
Practice Address - Country:US
Practice Address - Phone:626-391-2762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker