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NPI Code Detail

MEDICARE: MR. ROBERT STEPHEN ULLOM CASI

MEDICARE: MR. ROBERT STEPHEN ULLOM CASI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19442OTHERCACAARR

General Provider Information

NPI Number : 1164749222
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT STEPHEN ULLOM CASI
Provider Business Mailing Address
First Line : 145 BOST AVE
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-3249
Country : US
Telephone Number : 530-265-9045
Fax Number :
Provider Business Practice Location Address
First Line : 145 BOST AVE
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-3249
Country : US
Telephone Number : 530-265-9045
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2010
Last Update Date : 04/29/2010

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