Healthcare Provider Details

I. General information

NPI: 1104305556
Provider Name (Legal Business Name): FEDERICO S CABATAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27910 AGAPANTHUS LN
VALENCIA CA
91354-4927
US

IV. Provider business mailing address

27910 AGAPANTHUS LN
VALENCIA CA
91354-4927
US

V. Phone/Fax

Practice location:
  • Phone: 661-645-1239
  • Fax:
Mailing address:
  • Phone: 661-645-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number63790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: