MEDICARE: MICHAEL ANTHONY CACERES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	61453	CA

General Provider Information

NPI Number	:	1790247807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANTHONY CACERES

Provider Business Mailing Address
First Line	:	13474 GOLETA ST
Second Line	:
City	:	ARLETA
State	:	CA
Zip	:	91331-4615
Country	:	US
Telephone Number	:	818-744-1498
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-2209
Country	:	US
Telephone Number	:	818-581-6069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	04/05/2019

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