Healthcare Provider Details

I. General information

NPI: 1194300020
Provider Name (Legal Business Name): ALFONSO CABADA GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 PALOMAR AIRPORT RD STE 305
CARLSBAD CA
92011-1426
US

IV. Provider business mailing address

3946 UTAH ST UNIT 5
SAN DIEGO CA
92104-2954
US

V. Phone/Fax

Practice location:
  • Phone: 760-710-2460
  • Fax:
Mailing address:
  • Phone: 619-713-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: