Healthcare Provider Details

I. General information

NPI: 1336195429
Provider Name (Legal Business Name): ENRIQUE CACERES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 N. MCCOLL SUITE B
MCALLEN TX
78504-2686
US

IV. Provider business mailing address

PO BOX 720395
MCALLEN TX
78504-0395
US

V. Phone/Fax

Practice location:
  • Phone: 956-686-6860
  • Fax: 956-686-6864
Mailing address:
  • Phone: 956-686-6860
  • Fax: 956-686-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ9990
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberJ9990
License Number StateTX

VIII. Authorized Official

Name: ENRIQUE CACERES
Title or Position: PRESIDENT
Credential: MD
Phone: 956-686-6860