Healthcare Provider Details

I. General information

NPI: 1508795097
Provider Name (Legal Business Name): CABRILLO CENTER FOR RHEUMATIC DISEASE APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
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: 619-334-4869
  • Fax: 619-334-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARELLA MABAQUIAO
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-334-4869