Healthcare Provider Details

I. General information

NPI: 1417144809
Provider Name (Legal Business Name): CECILIO M CABANSAG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 W 7TH ST
OXNARD CA
93030-6757
US

IV. Provider business mailing address

991 W 7TH ST
OXNARD CA
93030-6757
US

V. Phone/Fax

Practice location:
  • Phone: 805-486-1213
  • Fax: 805-486-2443
Mailing address:
  • Phone: 805-486-1213
  • Fax: 805-486-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA24098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: