Provider Demographics
NPI:1275720294
Name:CABINIAN, ANTONIO E (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:E
Last Name:CABINIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91908-0867
Mailing Address - Country:US
Mailing Address - Phone:619-267-0200
Mailing Address - Fax:
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:STE 209
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-470-7000
Practice Address - Fax:619-470-7009
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45959207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A459590Medicaid
CAA45959OtherMEDICARE PTAN
CAA45959Medicare PIN
CAA45959OtherMEDICARE PTAN