1780744474 NPI number — JULIO E CACERES DDS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780744474 NPI number — JULIO E CACERES DDS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIO E CACERES DDS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1780744474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
517 N MAIN STREET
Provider Second Line Business Mailing Address:
SUITE300
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-564-7610
Provider Business Mailing Address Fax Number:
714-564-1637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
517 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE300
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-564-7610
Provider Business Practice Location Address Fax Number:
714-564-1637
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CACERES
Authorized Official First Name:
JULIO
Authorized Official Middle Name:
EDUARDO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-564-0510

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G94066-01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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