Provider Demographics
NPI:1518184266
Name:CAESAR, LILY R (PA)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:R
Last Name:CAESAR
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:587 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5619
Mailing Address - Country:US
Mailing Address - Phone:619-382-3315
Mailing Address - Fax:619-761-5831
Practice Address - Street 1:145 THUNDER DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6010
Practice Address - Country:US
Practice Address - Phone:760-630-5487
Practice Address - Fax:760-630-2558
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 18552363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB222829Medicare PIN