Healthcare Provider Details

I. General information

NPI: 1972919876
Provider Name (Legal Business Name): JOSEPH P. CASAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 09/21/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

1538 UNION ST
SAN BERNARDINO CA
92411-2545
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA52163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: