Provider Demographics
NPI:1881797132
Name:CACERES, MAYRA ENID (MD)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:ENID
Last Name:CACERES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CALLE JUAN P DUARTE
Mailing Address - Street 2:URB. FLORAL PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3507
Mailing Address - Country:US
Mailing Address - Phone:787-759-8543
Mailing Address - Fax:
Practice Address - Street 1:1462 CALLE AUGUSTO RODRIGUEZ
Practice Address - Street 2:HOSPITAL PAVIA SANTURCE FACULTAD MEDICA
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-727-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH96850Medicare UPIN