Healthcare Provider Details

I. General information

NPI: 1336407964
Provider Name (Legal Business Name): RICARDO G CACDAC MD A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR SUITE C306
RANCHO MIRAGE CA
92270-4126
US

IV. Provider business mailing address

PO BOX 1157
RANCHO MIRAGE CA
92270-1157
US

V. Phone/Fax

Practice location:
  • Phone: 760-779-1828
  • Fax: 760-779-8246
Mailing address:
  • Phone: 760-779-1828
  • Fax: 760-779-8246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA525730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA525730
License Number StateCA

VIII. Authorized Official

Name: RICARDO G CACDAC
Title or Position: OWNER
Credential: M.D.
Phone: 760-779-1828