Healthcare Provider Details

I. General information

NPI: 1881797132
Provider Name (Legal Business Name): MAYRA ENID CACERES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 CALLE AUGUSTO RODRIGUEZ HOSPITAL PAVIA SANTURCE FACULTAD MEDICA
SANTURCE PR
00909
US

IV. Provider business mailing address

120 CALLE JUAN P DUARTE URB. FLORAL PARK
SAN JUAN PR
00917-3507
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-6060
  • Fax:
Mailing address:
  • Phone: 787-759-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14152
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: