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General NPI Number Information
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NPI Number | 1306068499
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Entity Type | Organization
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Legal Business Name | THEODORE GERARD A. CASPE, M.D., A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 12375 BASELINE RD SUITE 104
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739
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Country | US
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Telephone | 909-899-6969
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Fax | 909-899-9922
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Provider Business Mailing Address
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Address Line | 12375 BASELINE RD SUITE 104
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-5921
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Country | US
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Telephone | 909-899-6969
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Fax | 909-899-9922
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE GERARD AGUILAR CASPE
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Credential | MD
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Telephone | 909-899-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A97790
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License Number State | CA
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