Healthcare Provider Details

I. General information

NPI: 1154250066
Provider Name (Legal Business Name): CASONDRA M MEHESKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21167 RIESLING CT
APPLE VALLEY CA
92308-5871
US

IV. Provider business mailing address

21167 RIESLING CT
APPLE VALLEY CA
92308-5871
US

V. Phone/Fax

Practice location:
  • Phone: 760-792-7358
  • Fax:
Mailing address:
  • Phone: 760-792-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number756402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: