Healthcare Provider Details

I. General information

NPI: 1205204344
Provider Name (Legal Business Name): BEATRIZ CACERES NAZARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD STE 209
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

1185A HOUPT PHYSICIAN OFFICE BLDG. CB# 7236 170 MANNING DRIVE
CHAPEL HILL NC
27599-7236
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7804
  • Fax:
Mailing address:
  • Phone: 919-966-1178
  • Fax: 919-966-7629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021-01542
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101285219
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number0101285219
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: