Provider Demographics
NPI:1407237670
Name:CABANGCA, DENNIS MABANAG (FNP)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MABANAG
Last Name:CABANGCA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W I ST STE C
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3460
Mailing Address - Country:US
Mailing Address - Phone:209-704-1189
Mailing Address - Fax:
Practice Address - Street 1:600 W I ST STE C
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3460
Practice Address - Country:US
Practice Address - Phone:209-710-4124
Practice Address - Fax:209-710-4131
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-14
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily