Healthcare Provider Details

I. General information

NPI: 1215932793
Provider Name (Legal Business Name): PEDRO LIWANAG CAJATOR MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

1800 SULLIVAN AVE RM 101
DALY CITY CA
94015-2227
US

IV. Provider business mailing address

1800 SULLIVAN AVE RM 101
DALY CITY CA
94015-2227
US

V. Phone/Fax

Practice location:
  • Phone: 650-994-0459
  • Fax: 650-994-1450
Mailing address:
  • Phone: 650-994-0459
  • Fax: 650-994-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA52128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: