Provider Demographics
NPI:1295895027
Name:CACERES, ALVARO T (MD)
Entity type:Individual
Prefix:MR
First Name:ALVARO
Middle Name:T
Last Name:CACERES
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 1:1205 GARCES HWY
Mailing Address - Street 2:STE 201
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-3639
Mailing Address - Country:US
Mailing Address - Phone:661-725-6464
Mailing Address - Fax:
Practice Address - Street 1:1205 GARCES HWY
Practice Address - Street 2:STE 201
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3639
Practice Address - Country:US
Practice Address - Phone:661-725-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG377331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G377331Medicaid
CA00G377331OtherCHDP
CA00G377331Medicare ID - Type Unspecified
CA00G377331Medicaid