Individual
MR. LUIS ANTONIO CACERES VILLALTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3716 108TH ST, CORONA, NY 11368-2025
(718) 651-4000
Mailing address
3716 108TH ST, CORONA, NY 11368-2025
(718) 651-4000
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
310925-01
NY
Other
Enumeration date
05/30/2018
Last updated
07/07/2021
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