Provider Demographics
NPI:1356498992
Name:URETA, CESAR G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:G
Last Name:URETA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 E PALM CANYON DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1623
Mailing Address - Country:US
Mailing Address - Phone:415-577-0101
Mailing Address - Fax:
Practice Address - Street 1:777 E TAHQUITZ CANYON WAY STE 200
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6797
Practice Address - Country:US
Practice Address - Phone:415-577-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
NY021202103TC0700X
CAPSY19211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021202OtherSTATE OF NEW YORK LICENSE