MEDICARE: VATCHE CABAYAN MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	G54444	CA

General Provider Information

NPI Number	:	1295135804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VATCHE CABAYAN MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1599 TARA HILLS DR
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2519
Country	:	US
Telephone Number	:	510-724-4586
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 HILLTOP MALL RD STE 200
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-1949
Country	:	US
Telephone Number	:	510-724-4586
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VATCHE CABAYAN
Credential	:	M.D.
Telephone Number	:	510-724-4586

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	03/04/2015

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