Provider Demographics
NPI:1164611216
Name:CAJERO, NICTE
Entity Type:Individual
Prefix:
First Name:NICTE
Middle Name:
Last Name:CAJERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1200
Mailing Address - Country:US
Mailing Address - Phone:323-887-1917
Mailing Address - Fax:323-832-9224
Practice Address - Street 1:2450 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1200
Practice Address - Country:US
Practice Address - Phone:323-887-1917
Practice Address - Fax:323-832-9224
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner