Provider Demographics
NPI:1235659913
Name:CACERES KIANES, CHESIL (MD)
Entity Type:Individual
Prefix:
First Name:CHESIL
Middle Name:
Last Name:CACERES KIANES
Suffix:
Gender:F
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:PO BOX 29955
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0955
Mailing Address - Country:US
Mailing Address - Phone:939-281-2984
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE ARRECIFE
Practice Address - Street 2:VISTA DEL ATLANTICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:939-821-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR019680208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty