MEDICARE: MR. CAILIN DAYNE CABICO MS, ATC

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	390200000X	Student in an Organized Health Care Education/Training Program		HI
2	2255A2300X	Athletic Trainer	2000052397	CA

General Provider Information

NPI Number	:	1669955233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CAILIN DAYNE CABICO MS, ATC

Provider Business Mailing Address
First Line	:	6329 CAMINITO BASILIO
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7208
Country	:	US
Telephone Number	:	808-384-2458
Fax Number	:

Provider Business Practice Location Address
First Line	:	6329 CAMINITO BASILIO
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7208
Country	:	US
Telephone Number	:	808-384-2458
Fax Number	:

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	01/27/2023

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