Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DERRICK COEDNO CABICO
Active Sole Proprietor136A00000X · MENIFEE, CA
Registration Details
- NPI Number
- 1558943597
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 27, 2021 (4.9870728530795 yrs)
- Last Updated
- Apr 27, 2021
- License
-
86254119 (CA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
30394 LAMPLIGHTER LNMENIFEE, CA, 925846933Browse CA providers · Browse ZIP 92584
- Phone
- 9515002104
- Primary Specialty
-
136A00000X
136A00000X
- Additional Specialty
- 136A00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.