Healthcare Provider Details

I. General information

NPI: 1063010841
Provider Name (Legal Business Name): CASEY CAROL RETIRO FULINARA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASEY FULINARA

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 870
LA JOLLA CA
92037-1233
US

IV. Provider business mailing address

9850 GENESEE AVE STE 870
LA JOLLA CA
92037-1233
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-7040
  • Fax:
Mailing address:
  • Phone: 858-452-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: