1205204344 NPI number — BEATRIZ CACERES NAZARIO

Table of content: BEATRIZ CACERES NAZARIO (NPI 1205204344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205204344 NPI number — BEATRIZ CACERES NAZARIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CACERES NAZARIO
Provider First Name:
BEATRIZ
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205204344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1185A HOUPT PHYSICIAN OFFICE BLDG.
Provider Second Line Business Mailing Address:
CB# 7236 170 MANNING DRIVE
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27599-7236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-966-1178
Provider Business Mailing Address Fax Number:
919-966-7629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5875 BREMO RD STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-287-7804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  2021-01542 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 0101285219 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0000X , with the licence number: 0101285219 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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