Provider Demographics
NPI:1023589322
Name:MARC CABANNE DO INC
Entity type:Organization
Organization Name:MARC CABANNE DO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:B
Authorized Official - Last Name:CABANNE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-365-9590
Mailing Address - Street 1:1625 CREEKSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3819
Mailing Address - Country:US
Mailing Address - Phone:916-365-9590
Mailing Address - Fax:916-292-8098
Practice Address - Street 1:1625 CREEKSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3819
Practice Address - Country:US
Practice Address - Phone:916-365-9590
Practice Address - Fax:916-292-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12580OtherCA MED LICENSE