Provider Demographics
NPI:1801813720
Name:CABACCAN, JOSELITO C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSELITO
Middle Name:C
Last Name:CABACCAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 S WHITE RD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2076
Mailing Address - Country:US
Mailing Address - Phone:408-223-7000
Mailing Address - Fax:408-223-7001
Practice Address - Street 1:2690 S WHITE RD STE 50
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2075
Practice Address - Country:US
Practice Address - Phone:408-223-7000
Practice Address - Fax:408-223-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78885207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110008961OtherRRW MEDICARE GRP
CA00A788850Medicare PIN
CAI16663Medicare UPIN
CA110008961OtherRRW MEDICARE GRP