Provider Demographics
NPI:1043821259
Name:CABANYOG, ISAAC J
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:J
Last Name:CABANYOG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S SAN FRANCISCO ST APT 213
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-0498
Mailing Address - Country:US
Mailing Address - Phone:602-326-0093
Mailing Address - Fax:
Practice Address - Street 1:1500 S SAN FRANCISCO ST APT 213
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0498
Practice Address - Country:US
Practice Address - Phone:602-326-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program