Healthcare Provider Details

I. General information

NPI: 1609333673
Provider Name (Legal Business Name): JULIO E CACERES DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W GRAND BLVD STE 111
CORONA CA
92882-2059
US

IV. Provider business mailing address

80 W GRAND BLVD STE 111
CORONA CA
92882-2059
US

V. Phone/Fax

Practice location:
  • Phone: 951-549-1111
  • Fax: 951-549-1190
Mailing address:
  • Phone: 951-549-1111
  • Fax: 951-549-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JULIO E CACERES
Title or Position: OWNER
Credential: DDS
Phone: 951-549-1111