Healthcare Provider Details

I. General information

NPI: 1740100973
Provider Name (Legal Business Name): JESUS RAFAEL CAZARES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3703
SONORA CA
95370-8735
US

IV. Provider business mailing address

PO BOX 3703
SONORA CA
95370-8735
US

V. Phone/Fax

Practice location:
  • Phone: 209-694-9746
  • Fax:
Mailing address:
  • Phone: 209-694-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3937436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: