Healthcare Provider Details

I. General information

NPI: 1689006363
Provider Name (Legal Business Name): CABRILLO CENTER FOR RHEUMATIC DISEASE APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CAMINO DE LA SIESTA STE 106
SAN DIEGO CA
92108-3117
US

IV. Provider business mailing address

5030 CAMINO DE LA SIESTA STE 106
SAN DIEGO CA
92108-3117
US

V. Phone/Fax

Practice location:
  • Phone: 619-334-4869
  • Fax: 619-334-4940
Mailing address:
  • Phone: 866-284-2771
  • Fax: 619-334-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARTHUR RAY MABAQUIAO
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 866-284-2771