=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912379835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VATCHE CABAYAN MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2015
-----------------------------------------------------
Last Update Date | 10/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2260 GLADSTONE DR STE. 7
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565-5125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-724-4586
-----------------------------------------------------
Fax | 510-724-9247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2970 HILLTOP MALL RD 200
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94806-1947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-724-4586
-----------------------------------------------------
Fax | 510-724-9247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. KATIA CABAYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-724-4586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | G54444
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------