Provider Demographics
NPI:1609555655
Name:CABACANG, MARILOW PINO
Entity Type:Individual
Prefix:
First Name:MARILOW
Middle Name:PINO
Last Name:CABACANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15610 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4905
Mailing Address - Country:US
Mailing Address - Phone:951-902-7924
Mailing Address - Fax:
Practice Address - Street 1:15610 OLIVER ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4905
Practice Address - Country:US
Practice Address - Phone:951-902-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95041798163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse