Healthcare Provider Details

I. General information

NPI: 1548193261
Provider Name (Legal Business Name): SUSANA CASAS-CANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 ARROW HWY
MONTCLAIR CA
91763-1697
US

IV. Provider business mailing address

5541 ARROW HWY
MONTCLAIR CA
91763-1697
US

V. Phone/Fax

Practice location:
  • Phone: 626-421-5938
  • Fax:
Mailing address:
  • Phone: 626-421-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number94604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: