Provider Demographics
NPI:1326845819
Name:CAZARES, CORITA VICTORIA (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:CORITA
Middle Name:VICTORIA
Last Name:CAZARES
Suffix:
Gender:
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N T AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-1848
Mailing Address - Country:US
Mailing Address - Phone:619-274-3077
Mailing Address - Fax:
Practice Address - Street 1:2405 MORENA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4139
Practice Address - Country:US
Practice Address - Phone:619-699-9328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist