Provider Demographics
NPI:1396710133
Name:ANTONIO E CABINIAN A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ANTONIO E CABINIAN A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CABINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-267-0200
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91908-0867
Mailing Address - Country:US
Mailing Address - Phone:619-267-0200
Mailing Address - Fax:619-267-9870
Practice Address - Street 1:751 MEDICAL CENTER CT
Practice Address - Street 2:SHARP CHULA VISTA MEDICAL CENTER
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6617
Practice Address - Country:US
Practice Address - Phone:619-267-0200
Practice Address - Fax:619-267-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45959207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A459590Medicaid
CAA45959OtherMEDICARE PTAN
CA00A459590Medicaid
CAA45959OtherMEDICARE PTAN