Basic Information
Provider Information
NPI: 1114285640
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAIN
FirstName: DAVID
MiddleName: JEFFREY
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 969096
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921969096
CountryCode: US
TelephoneNumber: 8584950971
FaxNumber: 8584950991
Practice Location
Address1: 31700 TEMECULA PKWY
Address2:  
City: TEMECULA
State: CA
PostalCode: 925925896
CountryCode: US
TelephoneNumber: 9513312200
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/03/2012
LastUpdateDate: 08/17/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X20A14685CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home