Provider Demographics
NPI:1962796672
Name:CABICO, ROBERT LUIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LUIS
Last Name:CABICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BROADWAY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2780
Mailing Address - Country:US
Mailing Address - Phone:619-425-8212
Mailing Address - Fax:
Practice Address - Street 1:1111 BROADWAY
Practice Address - Street 2:SUITE 305
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2780
Practice Address - Country:US
Practice Address - Phone:619-425-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine