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Individual
JORGE BASTIDAS CACERES
Active
Individual
JORGE BASTIDAS CACERES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
PT35690
CA
Other
Enumeration date
12/13/2012
Last updated
05/16/2024
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