1912379835 NPI number — VATCHE CABAYAN MEDICAL CORPORATION

Table of content: (NPI 1912379835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912379835 NPI number — VATCHE CABAYAN MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VATCHE CABAYAN MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1912379835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2970 HILLTOP MALL RD
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94806-1947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-724-4586
Provider Business Mailing Address Fax Number:
510-724-9247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2260 GLADSTONE DR
Provider Second Line Business Practice Location Address:
STE. 7
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94565-5125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-724-4586
Provider Business Practice Location Address Fax Number:
510-724-9247
Provider Enumeration Date:
10/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CABAYAN
Authorized Official First Name:
KATIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
510-724-4586

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  G54444 , 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)





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