Provider Demographics
NPI:1477759371
Name:CACHO, VINCE PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:VINCE PATRICK
Middle Name:
Last Name:CACHO
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 1:800 S CENTRAL AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4379
Mailing Address - Country:US
Mailing Address - Phone:818-844-2300
Mailing Address - Fax:
Practice Address - Street 1:800 S CENTRAL AVE STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4379
Practice Address - Country:US
Practice Address - Phone:188-442-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105666208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics