Provider Demographics
NPI:1295698207
Name:SAN MIGUEL, CESAR (CMT)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:SAN MIGUEL
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 AILEEN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2817
Mailing Address - Country:US
Mailing Address - Phone:510-269-3609
Mailing Address - Fax:
Practice Address - Street 1:3527 GRAND AVE STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2045
Practice Address - Country:US
Practice Address - Phone:510-214-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-05
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist