Provider Demographics
NPI:1407504129
Name:CACERES, JANICE (PA)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:CACERES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 URB.PASEOS PALMA REAL
Mailing Address - Street 2:CALLE GAVIOTA I-22
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:939-255-4388
Mailing Address - Fax:
Practice Address - Street 1:178 URB.PASEOS PALMA REAL
Practice Address - Street 2:CALLE GAVIOTA I-22
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:939-255-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23428208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice