Healthcare Provider Details

I. General information

NPI: 1821283524
Provider Name (Legal Business Name): JOSELITO CABACCAN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S WHITE RD SUITE 265
SAN JOSE CA
95148-2074
US

IV. Provider business mailing address

2680 S WHITE RD SUITE 265
SAN JOSE CA
95148-2074
US

V. Phone/Fax

Practice location:
  • Phone: 408-223-7000
  • Fax: 408-223-7001
Mailing address:
  • Phone: 408-223-7000
  • Fax: 408-223-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA78885
License Number StateCA

VIII. Authorized Official

Name: DR. JOSELITO C CABACCAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 408-223-7000