Derrick Coedno Cabico

Primary specialty

Registered Dietetic TechnicianTaxonomy code 136A00000X

License

86254119 Issued in CA

Practice address

30394 Lamplighter LN
Menifee, CA 92584-6933

Phone

(951) 500-2104

NPI assigned

Apr 27, 2021

Last updated

Apr 27, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1558943597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30394 LAMPLIGHTER LN",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925846933",
            "telephone_number": "951-500-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30394 LAMPLIGHTER LN",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925846933",
            "telephone_number": "951-500-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CABICO",
        "first_name": "DERRICK",
        "middle_name": "COEDNO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-27",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "136A00000X",
            "taxonomy_group": "",
            "desc": "Dietetic Technician, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "136A00000X",
            "taxonomy_group": "",
            "desc": "Dietetic Technician, Registered",
            "state": "CA",
            "license": "86254119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carla Busto, MD
• Ashley Butler
• Mina Butler
• C Foster, MFT, Inc
• Julianna Marguerite Caballero
• Darling Cabrera
• Lance Pasabing Cacanindin, ATC
• Alexia Caceres
• Anjun Cai
• Connie Cai, PHARMD

• Registered Dietetic Technician in Menifee, CA
• Providers in Menifee, CA by specialty
• Registered Dietetic Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.