Provider Demographics
NPI:1134113186
Name:CACHERIS, PHILLIP M (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:CACHERIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19951 MARINER AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1672
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7054
Practice Address - Street 1:19951 MARINER AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1672
Practice Address - Country:US
Practice Address - Phone:310-225-3244
Practice Address - Fax:310-698-7054
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62203207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A622030Medicaid
CA00A622031Medicare ID - Type Unspecified
CA00A622030Medicaid