Healthcare Provider Details

I. General information

NPI: 1578848347
Provider Name (Legal Business Name): MARC B CABANNE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 CREEKSIDE DR STE 200
FOLSOM CA
95630-3819
US

IV. Provider business mailing address

2001 RATTLESNAKE RD
NEWCASTLE CA
95658-9722
US

V. Phone/Fax

Practice location:
  • Phone: 916-365-9590
  • Fax: 916-292-8098
Mailing address:
  • Phone: 916-663-2100
  • Fax: 916-663-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number20A12580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: