Provider Demographics
NPI:1780669697
Name:CABISON, GRETHEL ALBA (MD)
Entity Type:Individual
Prefix:
First Name:GRETHEL
Middle Name:ALBA
Last Name:CABISON
Suffix:
Gender:F
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:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0007
Mailing Address - Country:US
Mailing Address - Phone:909-783-9111
Mailing Address - Fax:909-783-9112
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-2440
Practice Address - Fax:909-580-2441
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35550207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050091367OtherRAILROAD MEDICARE
CA00A355500Medicaid
00A355500OtherBLUE SHIELD
00A355501Medicare ID - Type Unspecified
00A355500OtherBLUE SHIELD