Healthcare Provider Details

I. General information

NPI: 1679320097
Provider Name (Legal Business Name): DHANA CABANTAC REMOT REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 MARSOPA DR
VISTA CA
92081-6437
US

IV. Provider business mailing address

2932 LUCIA JADE LOOP
SAN DIEGO CA
92139-3700
US

V. Phone/Fax

Practice location:
  • Phone: 727-687-9431
  • Fax:
Mailing address:
  • Phone: 727-687-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number95128249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: