Healthcare Provider Details

I. General information

NPI: 1184013021
Provider Name (Legal Business Name): SILVANO CAZARES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 AIRWAY AVE UNIT
COSTA MESA CA
92626-4652
US

IV. Provider business mailing address

129 S MELROSE ST APT 3
ANAHEIM CA
92805-4039
US

V. Phone/Fax

Practice location:
  • Phone: 714-689-1380
  • Fax:
Mailing address:
  • Phone: 559-827-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: