Provider Demographics
NPI:1073878724
Name:CACHOLA, JEREMY MORALES (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:MORALES
Last Name:CACHOLA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 W SIERRA SUNSET TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8079
Mailing Address - Country:US
Mailing Address - Phone:847-651-4885
Mailing Address - Fax:
Practice Address - Street 1:1823 W SIERRA SUNSET TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8079
Practice Address - Country:US
Practice Address - Phone:623-444-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171872-30367500000X
AZ184230367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered