Provider Demographics
NPI:1831654839
Name:CABABAT, ALLANJAY (RN)
Entity Type:Individual
Prefix:
First Name:ALLANJAY
Middle Name:
Last Name:CABABAT
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 1:10100 TRINITY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7239
Mailing Address - Country:US
Mailing Address - Phone:209-953-3700
Mailing Address - Fax:209-468-7042
Practice Address - Street 1:10100 TRINITY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7239
Practice Address - Country:US
Practice Address - Phone:209-953-3700
Practice Address - Fax:209-468-7042
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95048864163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse