Healthcare Provider Details

I. General information

NPI: 1407893027
Provider Name (Legal Business Name): CAESAR S. INES M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 N 3RD ST SUITE 307
PHOENIX AZ
85020-2439
US

IV. Provider business mailing address

91-1053 HOKUIKEKAI ST
EWA BEACH HI
96706
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-6316
  • Fax: 602-870-6091
Mailing address:
  • Phone: 623-252-7790
  • Fax: 808-597-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35044
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD 10688
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: