Provider Demographics
NPI:1447957857
Name:CAYABYAB, ANDRE MARK (DC)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:MARK
Last Name:CAYABYAB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16523 POPPYGLEN LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2091
Mailing Address - Country:US
Mailing Address - Phone:818-730-6276
Mailing Address - Fax:
Practice Address - Street 1:18575 GALE AVE STE 265
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1384
Practice Address - Country:US
Practice Address - Phone:626-623-8684
Practice Address - Fax:626-768-2977
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor