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Organization
CACERES MEDICAL GROUP, INC
Active
Organization
CACERES MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE ANGEL CACERES M.D. (CEO)
(714) 821-8588
Entity
Organization
Contact information
Practice address
8585 KNOTT AVE STE 101, BUENA PARK, CA 90620-3896
(714) 821-4482
Mailing address
8585 KNOTT AVE STE 101, BUENA PARK, CA 90620-3896
(714) 821-4482
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A479010
—
CA
05
—
00A897280
—
CA
01
—
A47901
DR CACERES LIC NUMBER
CA
01
—
A72193
DR GONZALES LIC NUMBER
CA
01
—
A89728
DR CAMARILLO LIC NUMBER
AR
05
—
GR0098890
—
CA
01
—
ZZZ09814Z
BLUE SHEILD GRP NUM
CA
Enumeration date
11/28/2006
Last updated
08/22/2020
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