Healthcare Provider Details

I. General information

NPI: 1407785835
Provider Name (Legal Business Name): MR. SERGIO CASAREZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25594 SIERRA LEONE CT
MORENO VALLEY CA
92551-2169
US

IV. Provider business mailing address

25594 SIERRA LEONE CT
MORENO VALLEY CA
92551-2169
US

V. Phone/Fax

Practice location:
  • Phone: 951-542-4149
  • Fax:
Mailing address:
  • Phone: 951-542-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: