Provider Demographics
NPI:1831108786
Name:GANCAYCO, JOSE G (RN)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:G
Last Name:GANCAYCO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 REGENTS RD
Mailing Address - Street 2:UNIT # L225
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9199
Mailing Address - Country:US
Mailing Address - Phone:914-625-8901
Mailing Address - Fax:
Practice Address - Street 1:9888 GENESEE AVE.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-678-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA665064163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine