Provider Demographics
NPI:1689006363
Name:CABRILLO CENTER FOR RHEUMATIC DISEASE APC
Entity Type:Organization
Organization Name:CABRILLO CENTER FOR RHEUMATIC DISEASE APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MABAQUIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-284-2771
Mailing Address - Street 1:5030 CAMINO DE LA SIESTA STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3117
Mailing Address - Country:US
Mailing Address - Phone:866-284-2771
Mailing Address - Fax:619-334-4940
Practice Address - Street 1:5030 CAMINO DE LA SIESTA STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3117
Practice Address - Country:US
Practice Address - Phone:619-334-4869
Practice Address - Fax:619-334-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61769207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty