Healthcare Provider Details

I. General information

NPI: 1336465111
Provider Name (Legal Business Name): KATHERINE GABON CADACIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LN KAISER PERMANENTE - STOCKTON
STOCKTON CA
95210-3377
US

IV. Provider business mailing address

7373 WEST LN KAISER PERMANENTE - STOCKTON
STOCKTON CA
95210-3377
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-3484
  • Fax:
Mailing address:
  • Phone: 209-476-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA124995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: