1578848347 NPI number — MARC B CABANNE DO

Table of content: MARC B CABANNE DO (NPI 1578848347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578848347 NPI number — MARC B CABANNE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABANNE
Provider First Name:
MARC
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578848347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 RATTLESNAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWCASTLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95658-9722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-663-2100
Provider Business Mailing Address Fax Number:
916-663-2103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 CREEKSIDE DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-3819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-365-9590
Provider Business Practice Location Address Fax Number:
916-292-8098
Provider Enumeration Date:
10/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  20A12580 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20A12580 . This is a "OSTEOPATHIC BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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