Provider Demographics
NPI:1144459629
Name:CABRERA, JENNIFER R (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
Last Name:CABRERA
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1734 S WESTGATE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3857
Mailing Address - Country:US
Mailing Address - Phone:805-252-1110
Mailing Address - Fax:310-945-2040
Practice Address - Street 1:1734 S WESTGATE AVE APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3857
Practice Address - Country:US
Practice Address - Phone:805-252-1110
Practice Address - Fax:310-945-2040
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20376363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant