Provider Demographics
NPI:1609464080
Name:CABATU, JOSHUA PEREZ (PA-S)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PEREZ
Last Name:CABATU
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-808-1012
Mailing Address - Fax:
Practice Address - Street 1:150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:419-530-5408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-01
Last Update Date:2022-02-18
Deactivation Date:2022-01-15
Deactivation Code:
Reactivation Date:2022-02-17
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5601010995363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program