Healthcare Provider Details

I. General information

NPI: 1144774878
Provider Name (Legal Business Name): CESAR CACERES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 07/17/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 N SIERRA BONITA AVE
PASADENA CA
91104-3147
US

IV. Provider business mailing address

1228 N SIERRA BONITA AVE
PASADENA CA
91104-3147
US

V. Phone/Fax

Practice location:
  • Phone: 818-481-4404
  • Fax:
Mailing address:
  • Phone: 818-481-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number754541
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: