Healthcare Provider Details

I. General information

NPI: 1265353387
Provider Name (Legal Business Name): EDGAR CAZARES LCSW, PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TIGER WAY
ROSEVILLE CA
95678-1706
US

IV. Provider business mailing address

1 TIGER WAY
ROSEVILLE CA
95678-1706
US

V. Phone/Fax

Practice location:
  • Phone: 916-583-3960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: