Provider Demographics
NPI:1417144809
Name:CABANSAG, CECILIO M (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIO
Middle Name:M
Last Name:CABANSAG
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 1:991 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6757
Mailing Address - Country:US
Mailing Address - Phone:805-486-1213
Mailing Address - Fax:805-486-2443
Practice Address - Street 1:991 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6757
Practice Address - Country:US
Practice Address - Phone:805-486-1213
Practice Address - Fax:805-486-2443
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24098207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A240980Medicaid
CAA24098Medicare PIN
CA00A240980Medicaid