Healthcare Provider Details

I. General information

NPI: 1891579645
Provider Name (Legal Business Name): ANGELINA CHRISTINE CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8526 HICKORY LN
RIVERSIDE CA
92504-2915
US

IV. Provider business mailing address

21891 OTOE RD
APPLE VALLEY CA
92307-7104
US

V. Phone/Fax

Practice location:
  • Phone: 951-706-0028
  • Fax:
Mailing address:
  • Phone: 760-912-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: