Provider Demographics
NPI:1417382094
Name:CACERES, JORGE JAVIER II (NP)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:JAVIER
Last Name:CACERES
Suffix:II
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3108
Mailing Address - Country:US
Mailing Address - Phone:956-381-9530
Mailing Address - Fax:956-316-9449
Practice Address - Street 1:1517 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3108
Practice Address - Country:US
Practice Address - Phone:956-381-5300
Practice Address - Fax:956-931-6544
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346227703Medicaid
TX332385YLPSOtherWELLMED PTAN