Basic Information
| Provider Information | |||||||||
| NPI: | 1639665839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRIZALES | ||||||||
| FirstName: | CESAR | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73547 26TH ST | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490656691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692006819 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 M 139 | ||||||||
| Address2: | |||||||||
| City: | BENTON HARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490223881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558696900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2018 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5201009879 | MI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 363AM0700X | 5601010064 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.