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Individual

DERRICK COEDNO CABICO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
30394 LAMPLIGHTER LN, MENIFEE, CA 92584-6933
(951) 500-2104
Mailing address
30394 LAMPLIGHTER LN, MENIFEE, CA 92584-6933
(951) 500-2104

Taxonomy

Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
86254119
CA
136A00000X
Registered Dietetic Technician

Other

Enumeration date
04/27/2021
Last updated
04/27/2021
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