Healthcare Provider Details

I. General information

NPI: 1104157106
Provider Name (Legal Business Name): REMEDIOS R. CABANSAG , MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 SO. FREEWAY SUITE 254
FORT WORTH TX
76115-0337
US

IV. Provider business mailing address

11803 SO. FREEWAY SUITE 254
FORT WORTH TX
76115-0337
US

V. Phone/Fax

Practice location:
  • Phone: 817-551-2963
  • Fax: 817-568-1663
Mailing address:
  • Phone: 817-551-2963
  • Fax: 817-568-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD9958
License Number StateTX

VIII. Authorized Official

Name: DR. REMEDIOS R. CABANSAG
Title or Position: PRESIDENT,VICE PRESIDENT,SEC/TREAS
Credential: MD
Phone: 817-551-2963