Healthcare Provider Details

I. General information

NPI: 1942117163
Provider Name (Legal Business Name): KIMBERLY CACEROS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

IV. Provider business mailing address

442 GULF AVE
WILMINGTON CA
90744-5225
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-4556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95417910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: