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General NPI Number Information
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NPI Number | 1790247807
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY CACERES
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Gender | Male
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 101 W ALAMEDA AVE
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City | BURBANK
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State | CA
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Zip | 91502-2209
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Country | US
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Telephone | 818-581-6069
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Fax |
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Provider Business Mailing Address
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Address Line | 13474 GOLETA ST
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City | ARLETA
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State | CA
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Zip | 91331-4615
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Country | US
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Telephone | 818-744-1498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 61453
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License Number State | CA
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