Provider Demographics
NPI:1083888739
Name:CACERES, CATHERINE MARIEL (RPA-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIEL
Last Name:CACERES
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 BAY BOUQUET LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-9311
Mailing Address - Country:US
Mailing Address - Phone:516-312-7346
Mailing Address - Fax:
Practice Address - Street 1:10211 ALM ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8221
Practice Address - Country:US
Practice Address - Phone:919-206-4889
Practice Address - Fax:919-206-4875
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012505363AM0700X
NC0010-02639363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical