| Theodore Gerard A. Caspe, M.d., A Medical Corporation | |
|
12375 Baseline Rd Suite 104 Rancho Cucamonga CA 91739 | |
| (909) 899-6969 | |
| (909) 899-9922 |
| Full Name | Theodore Gerard A. Caspe, M.d., A Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 12375 Baseline Rd, Rancho Cucamonga, California |
| Authorized Official Name and Position | Theodore Gerard Aguilar Caspe (PRESIDENT) |
| Authorized Official Contact | 9098996969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore Gerard A. Caspe, M.d., A Medical Corporation 12375 Baseline Rd Suite 104 Rancho Cucamonga CA 91739-5921 Ph: (909) 899-6969 | Theodore Gerard A. Caspe, M.d., A Medical Corporation 12375 Baseline Rd Suite 104 Rancho Cucamonga CA 91739 Ph: (909) 899-6969 |
| NPI Number | 1306068499 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 10/31/2007 |
| Medicare PECOS PAC ID | 3678656261 |
|---|---|
| Medicare Enrollment ID | O20080205000466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306068499 | NPI | - | NPPES |
| 1942349113 | Other | CA | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A97790 (California) | Primary |
| Provider Name | Theodore Gerard A Caspe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942349113 PECOS PAC ID: 5799866091 Enrollment ID: I20080111000723 |
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