Provider Demographics
NPI:1467032672
Name:CAGAYAO, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:CAGAYAO
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 1:825 CAMINITO CUMBRES
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-7058
Mailing Address - Country:US
Mailing Address - Phone:619-861-5147
Mailing Address - Fax:
Practice Address - Street 1:825 CAMINITO CUMBRES
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7058
Practice Address - Country:US
Practice Address - Phone:619-861-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA748409163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse