Provider Demographics
NPI:1912204645
Name:CAJAIBA, MARIANA MORAIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:MORAIS
Last Name:CAJAIBA
Suffix:
Gender:F
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:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:CRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:81131-0532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1202 HILLTOP WAY
Practice Address - Street 2:
Practice Address - City:CRESTONE
Practice Address - State:CO
Practice Address - Zip Code:81131-8113
Practice Address - Country:US
Practice Address - Phone:805-335-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC167903207ZP0101X
IN01067219A207ZP0101X
MI4301114065207ZP0101X
CODR.0065364208D00000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice