Provider Demographics
NPI:1609812841
Name:CABASSO, PHILLIP JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JOSEPH
Last Name:CABASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 E MIRA MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1223
Mailing Address - Country:US
Mailing Address - Phone:626-447-9397
Mailing Address - Fax:626-447-0094
Practice Address - Street 1:612 W DUARTE RD
Practice Address - Street 2:#303
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7602
Practice Address - Country:US
Practice Address - Phone:626-447-9397
Practice Address - Fax:626-447-0094
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G448850Medicaid
CAA49793Medicare UPIN
CA00G448850Medicaid