Provider Demographics
NPI:1992322390
Name:GARCIA CACERES, MARIO I
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:GARCIA CACERES
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2522
Mailing Address - Country:US
Mailing Address - Phone:786-306-0927
Mailing Address - Fax:
Practice Address - Street 1:310 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2522
Practice Address - Country:US
Practice Address - Phone:786-306-0927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7863060927Other7863060927