| Cable Street Family Practice And Medical Group, Inc. | |
|
1808 Cable St San Diego CA 92107-3103 | |
| (619) 221-4490 | |
| (619) 221-4494 |
| Full Name | Cable Street Family Practice And Medical Group, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1808 Cable St, San Diego, California |
| Authorized Official Name and Position | Noli A Cava (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6192214490 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cable Street Family Practice And Medical Group, Inc. 1808 Cable St San Diego CA 92107-3103 Ph: (619) 221-4490 | Cable Street Family Practice And Medical Group, Inc. 1808 Cable St San Diego CA 92107-3103 Ph: (619) 221-4490 |
| NPI Number | 1184834012 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 12/21/2015 |
| Medicare PECOS PAC ID | 7214112283 |
|---|---|
| Medicare Enrollment ID | O20110506000555 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184834012 | NPI | - | NPPES |
| W14659 | Other | CA | PTAN |
| 3836332 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | G84802 (California) | Primary |
| Provider Name | Noli A Cava |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265453435 PECOS PAC ID: 3678541281 Enrollment ID: I20040921001363 |
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