Provider Demographics
NPI:1881676302
Name:DUA, CESAR L (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:L
Last Name:DUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5801
Mailing Address - Country:US
Mailing Address - Phone:626-346-2455
Mailing Address - Fax:626-639-3005
Practice Address - Street 1:3946 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3300
Practice Address - Country:US
Practice Address - Phone:916-564-0521
Practice Address - Fax:877-860-2907
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046252208000000X
CAA62556208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA061413OtherBOARD CERTIFICATION #
CA00A625560OtherBLUE SHIELD OF CA PIN
CAP01498288OtherRAILROAD MEDICARE-DV5277
CAP01498288OtherRAILROAD MEDICARE-DV5277
CA00A625560OtherBLUE SHIELD OF CA PIN
CAP01498288OtherRAILROAD MEDICARE-DV5277
CAG61334Medicare UPIN