Individual
MR. KID JONATHAN CABRERA SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
815 SW BOND ST, BEND, OR 97702-3593
(541) 382-4900
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-4900
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202210845NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500811890
—
OR
Enumeration date
09/14/2022
Last updated
04/08/2024
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