Provider Demographics
NPI:1669716403
Name:CABAL, RONALD M (RN, BSN)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:CABAL
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 MOCKINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8832
Mailing Address - Country:US
Mailing Address - Phone:909-992-8256
Mailing Address - Fax:
Practice Address - Street 1:6917 MOCKINGBIRD CT
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-8832
Practice Address - Country:US
Practice Address - Phone:909-992-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520751163W00000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care