Healthcare Provider Details

I. General information

NPI: 1609690247
Provider Name (Legal Business Name): ABEL CAVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE STE 135
MODESTO CA
95350-4569
US

IV. Provider business mailing address

913 CRIPPEN AVE
MODESTO CA
95351-2920
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-5801
  • Fax:
Mailing address:
  • Phone: 209-818-2836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: