Provider Demographics
NPI:1821283524
Name:JOSELITO CABACCAN, MD
Entity Type:Organization
Organization Name:JOSELITO CABACCAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSELITO
Authorized Official - Middle Name:C
Authorized Official - Last Name:CABACCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-223-7000
Mailing Address - Street 1:2680 S WHITE RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2074
Mailing Address - Country:US
Mailing Address - Phone:408-223-7000
Mailing Address - Fax:408-223-7001
Practice Address - Street 1:2680 S WHITE RD
Practice Address - Street 2:SUITE 265
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2074
Practice Address - Country:US
Practice Address - Phone:408-223-7000
Practice Address - Fax:408-223-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78885207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A78885Medicare PIN