Healthcare Provider Details

I. General information

NPI: 1386971364
Provider Name (Legal Business Name): MANUEL EDGARDO CABEZAS HHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 ARVINELS AVE
SAN DIEGO CA
92117-2324
US

IV. Provider business mailing address

4980 ARVINELS AVE
SAN DIEGO CA
92117-2324
US

V. Phone/Fax

Practice location:
  • Phone: 858-229-7479
  • Fax:
Mailing address:
  • Phone: 858-229-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberB1995000055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: