Healthcare Provider Details

I. General information

NPI: 1083916985
Provider Name (Legal Business Name): STEPHEN CARL CASO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2010
Last Update Date: 11/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41715 WINCHESTER RD SUITE 101
TEMECULA CA
92590-4808
US

IV. Provider business mailing address

8432 VIA SONOMA UNIT 60
LA JOLLA CA
92037-2721
US

V. Phone/Fax

Practice location:
  • Phone: 951-308-4451
  • Fax:
Mailing address:
  • Phone: 570-401-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: