Provider Demographics
NPI:1376144014
Name:CARABBACAN, NICCOLO MCWIN MADRIGAL
Entity Type:Individual
Prefix:
First Name:NICCOLO MCWIN
Middle Name:MADRIGAL
Last Name:CARABBACAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 ASHFORD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5010
Mailing Address - Country:US
Mailing Address - Phone:619-791-9470
Mailing Address - Fax:
Practice Address - Street 1:7740 RANCHO SANTA FE RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8685
Practice Address - Country:US
Practice Address - Phone:760-753-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist