Healthcare Provider Details

I. General information

NPI: 1225276694
Provider Name (Legal Business Name): VATCHE CABAYAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 APPIAN WAY SUITE 205
PINOLE CA
94564-2576
US

IV. Provider business mailing address

2160 APPIAN WAY SUITE 205
PINOLE CA
94564-2576
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-4586
  • Fax: 510-724-9247
Mailing address:
  • Phone: 510-724-4586
  • Fax: 510-724-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG54444
License Number StateCA

VIII. Authorized Official

Name: DR. VATCHE CABAYAN
Title or Position: PRESIDENT
Credential: MD
Phone: 510-724-4586