Individual provider Active NPI

Jesse Caceres

  • Physical Therapy Assistant
  • Van Nuys, CA
National Provider Identifier
1063279610
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
54750 Issued in CA
Practice address
7100 Van Nuys Blvd Ste 103
Van Nuys, CA 91405-3063
Phone
(310) 504-3135
NPI assigned
Feb 29, 2024
Last updated
May 5, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 54750 CA Primary

Addresses

Primary practice location

7100 Van Nuys Blvd Ste 103
Van Nuys, CA 91405-3063

Mailing address

7100 Van Nuys Blvd Ste 103
Van Nuys, CA 91405-3063
Phone (310) 504-3135

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
54750CAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Profizix Physical Therapy and Wellness P.C. PastSince Oct 6, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1063279610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 VAN NUYS BLVD STE 103",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914053063",
            "telephone_number": "310-504-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 VAN NUYS BLVD STE 103",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914053063",
            "telephone_number": "310-504-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACERES",
        "first_name": "JESSE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-29",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "54750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.