Basic Information
| Provider Information | |||||||||
| NPI: | 1265641435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABRERA | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 S 24TH AVE | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785396533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562897025 | ||||||||
| FaxNumber: | 9562897257 | ||||||||
| Practice Location | |||||||||
| Address1: | 1242 N 77 SUNSHINESTRIP | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562897025 | ||||||||
| FaxNumber: | 9562897257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 724987 | TX | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 724987 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 138708613 | 05 | TX | MEDICAID | 00R945 | 01 | TX | MEDICARE | OTHER | 138708611 | 05 | TX | MEDICAID | 138708602 | 05 | TX | MEDICAID |