Healthcare Provider Details

I. General information

NPI: 1902369762
Provider Name (Legal Business Name): JOHN CABONCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 433
PASADENA CA
91101-2057
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 433
PASADENA CA
91101-2057
US

V. Phone/Fax

Practice location:
  • Phone: 626-206-3139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC8423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: