Provider Demographics
NPI:1952445728
Name:PEDRO L. CAJATOR MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PEDRO L. CAJATOR MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAJATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-357-7821
Mailing Address - Street 1:1800 SULLIVAN AVE RM 101
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2227
Mailing Address - Country:US
Mailing Address - Phone:650-994-0459
Mailing Address - Fax:650-994-1450
Practice Address - Street 1:1800 SULLIVAN AVE RM 101
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2227
Practice Address - Country:US
Practice Address - Phone:650-994-0459
Practice Address - Fax:650-994-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA521280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31116ZMedicare ID - Type Unspecified
CAF32771Medicare UPIN