Healthcare Provider Details

I. General information

NPI: 1073449344
Provider Name (Legal Business Name): SAMUEL CAESAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 LEWIS ST STE 102
GARDEN GROVE CA
92840-4698
US

IV. Provider business mailing address

25352 HILLARY LN
LAGUNA HILLS CA
92653-5217
US

V. Phone/Fax

Practice location:
  • Phone: 760-634-1125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: