Provider Demographics
NPI:1073069159
Name:CACERES SPECIALIZED GYNECOLOGY, LLC
Entity Type:Organization
Organization Name:CACERES SPECIALIZED GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-286-6222
Mailing Address - Street 1:15502 STONEYBROOK WEST PKWY
Mailing Address - Street 2:SUITE 104-241
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4767
Mailing Address - Country:US
Mailing Address - Phone:321-286-6222
Mailing Address - Fax:
Practice Address - Street 1:1530 CELEBRATION BLVD, SUITE 408
Practice Address - Street 2:SUITE 408
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-392-2777
Practice Address - Fax:407-605-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98869207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty