Healthcare Provider Details

I. General information

NPI: 1871942722
Provider Name (Legal Business Name): JORGE A CACERES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CALLE SAN RAFAEL
SAN JUAN PR
00909-2518
US

IV. Provider business mailing address

301 14TH AVE SW APT 343
ROCHESTER MN
55902-1978
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-7070
  • Fax: 305-355-2424
Mailing address:
  • Phone: 939-218-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number23756
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: