Basic Information
| Provider Information | |||||||||
| NPI: | 1881797132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CACERES | ||||||||
| FirstName: | MAYRA | ||||||||
| MiddleName: | ENID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 CALLE JUAN P DUARTE | ||||||||
| Address2: | URB. FLORAL PARK | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009173507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877598543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1462 CALLE AUGUSTO RODRIGUEZ | ||||||||
| Address2: | HOSPITAL PAVIA SANTURCE FACULTAD MEDICA | ||||||||
| City: | SANTURCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877276060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 14152 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.