Provider Demographics
NPI:1336195429
Name:ENRIQUE CACERES MD PA
Entity Type:Organization
Organization Name:ENRIQUE CACERES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-686-6860
Mailing Address - Street 1:PO BOX 720395
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0395
Mailing Address - Country:US
Mailing Address - Phone:956-686-6860
Mailing Address - Fax:956-686-6864
Practice Address - Street 1:4236 N. MCCOLL
Practice Address - Street 2:SUITE B
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2686
Practice Address - Country:US
Practice Address - Phone:956-686-6860
Practice Address - Fax:956-686-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9990208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142435001Medicaid
TX142435003Medicaid
TX142435002Medicaid
TX109700100OtherVALLEY HEALTH PLAN