Provider Demographics
NPI:1861444184
Name:ADVINCULA, GEOFFREY CABIGAO (PT)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:CABIGAO
Last Name:ADVINCULA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6178 CIVIC TERRACE AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3835
Mailing Address - Country:US
Mailing Address - Phone:510-415-6057
Mailing Address - Fax:
Practice Address - Street 1:6178A CIVIC TERRACE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3835
Practice Address - Country:US
Practice Address - Phone:510-415-6057
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT281350Medicare ID - Type Unspecified