Healthcare Provider Details

I. General information

NPI: 1912379835
Provider Name (Legal Business Name): VATCHE CABAYAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 GLADSTONE DR STE. 7
PITTSBURG CA
94565-5125
US

IV. Provider business mailing address

2970 HILLTOP MALL RD 200
RICHMOND CA
94806-1947
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 Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG54444
License Number StateCA

VIII. Authorized Official

Name: MRS. KATIA CABAYAN
Title or Position: MANAGER
Credential:
Phone: 510-724-4586