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NPI Code Detail

MEDICARE: MR. DENNIS CAEZAR CAVALTERA

MEDICARE:  MR. DENNIS CAEZAR CAVALTERA
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
1172A00000XDriver

General Provider Information

NPI Number : 1861074916
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS CAEZAR CAVALTERA
Provider Business Mailing Address
First Line : 1420 DILLSON RD
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92404-1544
Country : US
Telephone Number : 626-543-4964
Fax Number :
Provider Business Practice Location Address
First Line : 1420 DILLSON RD
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92404-1544
Country : US
Telephone Number : 626-543-4964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2021
Last Update Date : 04/27/2021

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Directions to “ MR. DENNIS CAEZAR CAVALTERA ” Practice Location

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