Provider Demographics
NPI:1346217213
Name:MORENO CABRAL, RICARDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:J
Last Name:MORENO CABRAL
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 1:550 WASHINGTON ST
Mailing Address - Street 2:STE 701
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-297-0008
Mailing Address - Fax:619-297-2498
Practice Address - Street 1:550 WASHINGTON ST STE 701
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2229
Practice Address - Country:US
Practice Address - Phone:619-297-0008
Practice Address - Fax:619-297-2498
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30738207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307381Medicaid
A26210Medicare UPIN
CA00A307381Medicaid