Provider Demographics
NPI:1568107225
Name:CAZAREZ, JORGE (CPT 9580)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CAZAREZ
Suffix:
Gender:M
Credentials:CPT 9580
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 PICCARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2538
Mailing Address - Country:US
Mailing Address - Phone:619-363-1074
Mailing Address - Fax:619-534-6333
Practice Address - Street 1:762 PICCARD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2538
Practice Address - Country:US
Practice Address - Phone:619-363-1074
Practice Address - Fax:619-534-6333
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT9580246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy