Healthcare Provider Details

I. General information

NPI: 1447066220
Provider Name (Legal Business Name): KEVIN CAYAGO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

184 LELAND AVE
SAN FRANCISCO CA
94134-2806
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95395532
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number95395532
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95395532
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95395532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: