Provider Demographics
NPI:1942609417
Name:CACERES, YUICSES (OTA12365)
Entity Type:Individual
Prefix:
First Name:YUICSES
Middle Name:
Last Name:CACERES
Suffix:
Gender:F
Credentials:OTA12365
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 NW 170TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4328
Mailing Address - Country:US
Mailing Address - Phone:305-632-4056
Mailing Address - Fax:
Practice Address - Street 1:4365 NW 170TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4328
Practice Address - Country:US
Practice Address - Phone:305-632-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12365225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist