Healthcare Provider Details

I. General information

NPI: 1932565637
Provider Name (Legal Business Name): MICHAEL CABERTO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 S SANTA CRUZ ST STE 215
ANAHEIM CA
92805-6821
US

IV. Provider business mailing address

3930 MCKINNEY AVE APT 433
DALLAS TX
75204-2071
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-2124
  • Fax:
Mailing address:
  • Phone: 714-349-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A16660
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ9586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: