MEDICARE: MR. JOSE G GANCAYCO RN

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	163WC0200X	Critical Care Medicine Registered Nurse	665064	CA

General Provider Information

NPI Number	:	1831108786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE G GANCAYCO RN

Provider Business Mailing Address
First Line	:	9229 REGENTS RD
Second Line	:	UNIT # L225
City	:	LA JOLLA
State	:	CA
Zip	:	92037-9199
Country	:	US
Telephone Number	:	914-625-8901
Fax Number	:

Provider Business Practice Location Address
First Line	:	9888 GENESEE AVE.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92037
Country	:	US
Telephone Number	:	858-678-7000
Fax Number	:

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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