Healthcare Provider Details

I. General information

NPI: 1992662068
Provider Name (Legal Business Name): RYAN EATON CASELLI RADT 1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W WASHINGTON AVE
ESCONDIDO CA
92025-1643
US

IV. Provider business mailing address

550 W WASHINGTON AVE
ESCONDIDO CA
92025-1643
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-6380
  • Fax: 760-294-7022
Mailing address:
  • Phone: 760-489-6380
  • Fax: 760-294-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number378703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: