MEDICARE: DR. ALELI CASINO MASAJO MD

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
1	208000000X	Pediatrics Physician	P3769	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396912762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALELI CASINO MASAJO MD

Provider Business Mailing Address
First Line	:	2148 JACKSON KELLER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2722
Country	:	US
Telephone Number	:	210-501-0703
Fax Number	:	210-526-0334

Provider Business Practice Location Address
First Line	:	2148 JACKSON KELLER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2722
Country	:	US
Telephone Number	:	210-501-0703
Fax Number	:	210-526-0334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	12/10/2014

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