Provider Demographics
NPI:1205928603
Name:CACERES, VICENTA (MD)
Entity type:Individual
Prefix:
First Name:VICENTA
Middle Name:
Last Name:CACERES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICENTA
Other - Middle Name:
Other - Last Name:CACERES DE LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:15TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:212-333-7883
Mailing Address - Fax:
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:15TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-333-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193906207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY193906OtherLICENSE