MEDICARE: SUSANA CABADA PHARMACY TECHNICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician	35329	CA

General Provider Information

NPI Number	:	1134459399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA CABADA PHARMACY TECHNICIAN

Provider Business Mailing Address
First Line	:	4031 MARINE VIEW AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-4332
Country	:	US
Telephone Number	:	619-215-3021
Fax Number	:

Provider Business Practice Location Address
First Line	:	4031 MARINE VIEW AVE.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113
Country	:	US
Telephone Number	:	619-215-3021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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