Healthcare Provider Details

I. General information

NPI: 1225995814
Provider Name (Legal Business Name): CACERES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
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: 714-821-8588
  • Fax: 714-821-4482
Mailing address:
  • Phone: 714-821-8588
  • Fax: 714-821-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SAMANTHA GAIL ANG
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-821-8588