Healthcare Provider Details

I. General information

NPI: 1558437541
Provider Name (Legal Business Name): CACERES MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 KNOTT AVE STE 101
BUENA PARK CA
90620-3896
US

IV. Provider business mailing address

8585 KNOTT AVE STE 101
BUENA PARK CA
90620-3896
US

V. Phone/Fax

Practice location:
  • Phone: 714-821-4482
  • Fax:
Mailing address:
  • Phone: 714-821-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE ANGEL CACERES
Title or Position: CEO
Credential: M.D.
Phone: 714-821-8588