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NPI Code Detail

MEDICARE: CASEY FLANEGIN-BUFFA

MEDICARE: CASEY FLANEGIN-BUFFA
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) CounselorR27231214CA

General Provider Information

NPI Number : 1508416850
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY FLANEGIN-BUFFA
Provider Business Mailing Address
First Line : 270 W 14TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-4396
Country : US
Telephone Number : 310-519-8723
Fax Number :
Provider Business Practice Location Address
First Line : 270 W 14TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-4396
Country : US
Telephone Number : 310-519-8723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2019
Last Update Date : 09/18/2019

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Directions to “ CASEY FLANEGIN-BUFFA ” Practice Location

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